Tristan Degot

Disseminated Trichosporon mycotoxinivorans, Aspergillus fumigatus, and Scedosporium apiospermum coinfection after lung and liver transplantation in a cystic fibrosis patient.

ABSTRACT Trichosporon mycotoxinivorans is a novel pathogen recently found in cystic fibrosis patients. We report the first case of a disseminated fatal infection with T. mycotoxinivorans associated with invasive Aspergillus fumigatus and Scedosporium apiospermum infection after lung and liver transplantation in a cystic fibrosis patient.

Clinical usefulness of oral immunoglobulins in lung transplant recipients with norovirus gastroenteritis: a case series.

Viral gastroenteritis causing diarrhea is a common complication observed in lung transplant recipients. Differently from the mild and typically self-limited disease seen in immunocompetent subjects, immunocompromised patients frequently have a more severe course. Norovirus and rotavirus are among the leading causes of severe gastroenteritis in transplant recipients. Specific treatment is unavailable, although good supportive treatment can significantly reduce morbidity. Previous studies have suggested that oral immunoglobulins may be used for the treatment of acute viral gastroenteritis after solid-organ transplantation. Herein, we conducted a retrospective chart review of 12 lung transplant recipients with norovirus-induced gastroenteritis who were treated with oral immunoglobulins for 2 days. Eleven patients were successfully treated, whereas 1 subject was only mildly improved. Four patients had at least 1 recurrence. No significant adverse effects were observed. We conclude that oral immunoglobulins may be clinically useful for lung transplant recipients with norovirus-induced gastroenteritis.

Brain abscesses caused by Cladophialophora bantiana in a lung transplant patient: A case report and review of the literature

Cladophialophora bantiana brain abscesses are rare, but are frequently and quickly lethal in transplanted patients. We report the case of a 63‐year‐old man who had undergone lung transplantation for chronic obstructive pulmonary disease and presented with headaches and a neurological deficit. Magnetic resonance imaging revealed multiple brain abscesses. C. bantiana was identified by DNA sequencing performed directly on cerebral tissue obtained by surgical biopsy. After 6 months of antifungal treatment, the brain abscesses were replaced by ischemic sequelae. The patient died suddenly 2 months later from a pulmonary bacterial infection. This is the second reported case of C. bantiana brain abscesses in a lung transplant recipient, to our knowledge, who experienced a long survival period with medical antifungal treatment alone. We review the literature and discuss our treatment.

First case of Arthrographis kalrae fungemia in a patient with cystic fibrosis

Arthrographis kalrae is a hyalin fungus. It is a saprophyte of the environment, mainly found in soil and compost. In recent years, cases of opportunistic infections attributed to this pathogen have been described. Our patient was a 19-year-old woman with cystic fibrosis. She presented a bacterial and fungal pulmonary colonization with Aspergillus fumigatus and Arthrographis. kalrae. After her lung transplantation, she developed an A. kalrae fungemia, treated with caspofungin 50 mg/day associated to liposomal amphotericin B i.v. 3 mg/kg/day. The patient died 8 months after her transplantation as the result of a bacterial septic shock.

Impact of diabetes mellitus on survival and hospitalization after lung transplantation

Introduction: Diabetes mellitus (DM) is a risk factor for mortality and morbidity after solid organ transplantation (kidney, liver). The objective of our study was to determine the effect of DM on survival and unscheduled hospitalizations after lung transplantation. Patients and methods: We included retrospectively 256 patients who received a single or double lung transplantation at Strasbourg University Hospital between 2004 and 2014. The indications for lung transplantation were: COPD (43,4%), cystic fibrosis (21,9%), and pulmonary fibrosis (19,2%). 80% were bilateral transplantations. We grouped the patients into 3 relevant categories of DM: pre- and post-transplant DM, new onset (>3 months) diabetes after transplantation (NODAT) and the control group of non-diabetic patients. Results: 78 patients had pre&post DM and 48 patients developed NODAT. Cystic fibrosis patients had the highest prevalence (50%) of pre&post DM and NODAT. We found a significant difference for unscheduled hospital stays between the 3 groups: the duration of hospital stays [mean±SD] was 86±121 days/year for pre&post DM patients, 50±67 days/year for NODAT, and 78±120 days/year for non-diabetic patients (p=0,032). We observed a worse survival after transplantation in pre&post DM compared to patients without pre-transplant DM (3-months median conditional survival: 6.3 ± 1.6 vs 8.8 ± 0.7 years, p = 0.016). There was no difference in survival for NODAT patients compared to non-diabetic patients (3 months conditional median survival: 10.5 ± 2 years versus 8.4 ± 1.6, NS). Conclusion: DM might have an impact on survival after lung transplantation. An organized and cooperative management of pre&post DM and NODAT seems warranted.