Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Long-Term Pulmonary Infections in Heart Transplant Recipients(2015) Kupeli, Elif; Ulubay, Gaye; Akkure, Esma Sevil; Eyuboglu, Fusun Oner; Sezgin, Atilla; 0000-0002-5525-8207; 0000-0002-5826-1997; 0000-0003-2478-9985; 25894190; AAR-4338-2020; AAB-5345-2021; AAB-5064-2021Objectives: Pulmonary infections are life-threatening complications in heart transplant recipients. Our aim was to evaluate long-term pulmonary infections and the effect of prophylactic antimicrobial strategies on time of occurrence of pulmonary infections in heart transplant recipients. Materials and Methods: Patients who underwent heart transplantation between 2003 and 2013 at Baskent University were reviewed. Demographic information and data about immunosuppression and infectious episodes were collected. Results: In 82 heart transplant recipients (mean age, 33.85 y; 58 male and 24 female), 13 recipients (15.8%) developed pulmonary infections (mean age, 44.3 y; 9 male and 4 female). There were 12 patients who had dilated cardiomyopathy and 1 patient who had myocarditis before heart transplantation; 12 patients received immunosuppressive therapy in single or combination form. Pulmonary infections developed in the first month (1 patient), from first to third month (6 patients), from third to sixth month (1 patient), and > 6 months after transplantation (5 patients). Chest computed tomography showed consolidation (unilateral, 9 patients; bilateral, 4 patients). Multiple nodular consolidations were observed in 2 patients and a cavitary lesion was detected in 1 patient. Bronchoscopy was performed in 6 patients; 3 patients had Aspergillus fumigatus growth in bronchoalveolar lavage fluid, and 2 patients had Acinetobacter baumannii growth in sputum. Treatment was empiric antibiotics (6 patients), antifungal drugs (5 patients), and both antibiotics and antifungal drugs (2 patients); treatment period was 1-12 months in patients with invasive pulmonary aspergillosis. Conclusions: Pulmonary infections are the most common cause of mortality in heart transplant recipients. A. fumigatus is the most common opportunistic pathogen. Heart transplant recipients with fever and cough should be evaluated for pulmonary infections, and invasive pulmonary aspergillosis should be suspected if these symptoms occur within the first 3 months. Immediately starting an empiric antibiotic is important in treating pulmonary infections in heart transplant recipients.Item Invasive Pulmonary Aspergillosis in Heart Transplant Recipients(2015) Kupeli, Elif; Ulubay, Gaye; Akkurt, Sevil Bayram; Eyulboglu, Fusun Oner; Sezgin, Atilla; 0000-0003-2478-9985; 0000-0002-5826-1997; 0000-0002-5525-8207; 25894189; AAB-5064-2021; AAB-5345-2021; AAR-4338-2020Objectives: Invasive pulmonary aspergillosis is the most common invasive mycosis in heart transplant recipients. Early clinical recognition of this complication is difficult and laboratory data is not specific. Our aim was to study the characteristics of invasive pulmonary aspergillosis infections in heart transplant recipients. Materials and Methods: Between 2007 and 2013, there were 82 patients who underwent heart transplant at our institution, including 6 patients who were diagnosed with invasive pulmonary aspergillosis. Medical records of these patients were reviewed for demographic, clinical, and radiographic features, microbiology data, serum galactomannan levels, antifungal treatment, and overall outcomes. Results: The most common species causing the infection was Aspergillus fumigatus. The infection was encountered irrespective of the duration since the transplant. Bronchoalveolar lavage with positive culture for Aspergillus species and/or abnormal serum galactomannan level was suggestive of invasive pulmonary aspergillosis. Conclusions: In our opinion, empiric antifungal therapy should be commenced as soon as invasive pulmonary aspergillosis is suspected in heart transplant recipients to reduce mortality. Although the duration of antifungal therapy for invasive pulmonary aspergillosis is debatable, heart transplant recipients may require long-term therapy to avoid recurrence.Item Role of Bronchoalveolar Lavage in Diagnosis of Fungal Infections in Liver Transplant Recipients(2015) Tepeoglu, Merih; Atilgan, Alev Ok; Ozdemir, B. Handan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0001-8595-8880; 0000-0002-7528-3557; 0000-0002-9894-8005; 25894185; AAJ-8097-2021; AAK-3333-2021; X-8540-2019; AAK-5222-2021Objectives: Pulmonary fungal infections remain the most important cause of morbidity and mortality in liver transplant recipients. Fast and accurate causative diagnoses are essential for a good outcome. Bronchoscopy with bronchoalveolar lavage frequently is performed to diagnose pulmonary infections in immunocompromised patients. The aim of this study was to evaluate the diagnostic use of bronchoalveolar lavage in liver transplant recipients with pulmonary infections. Materials and Methods: We retrospectively analyzed the data of 408 patients who underwent liver transplant from January 1990 to December 2012. Patients who underwent bronchoalveolar lavage after transplant were included in this study. Results: There were 18 of 408 liver transplant recipients (4.41%) who underwent bronchoalveolar lavage after transplant. The mean age was 49.5 +/- 18 years. In 5 patients (27.8%), fungal microorganisms were observed in the cytology of bronchoalveolar lavage specimens, including Aspergillus fumigatus in 3 patients and Candida albicans in 2 patients. Death occurred in 4 of 5 patients (80%) with fungal infections. No association was observed between the presence of fungal infection and clinical and radiographic findings of the patients. Conclusions: Bronchoscopy with bronchoalveolar lavage is a useful, noninvasive diagnostic tool for the rapid diagnosis of infections in solid-organ transplant recipients.Item Radiologically Occult Invasive Pulmonary Aspergillosis in a Patient With Liver Transplant(2018) Esendagli, Dorina; Serifoglu, Irem; Bozbas, Serife Savas; Tepeoglu, Merih; Akcay, Sule; Haberal, Mehmet; 0000-0002-6619-2952; 0000-0002-7230-202X; 0000-0002-9894-8005; 0000-0002-8360-6459; 0000-0002-3462-7632; 29528022; ABF-9398-2020; AAS-6628-2021; AAI-8064-2021; AAK-5222-2021; AAB-5175-2021; AAJ-8097-2021Invasive pulmonary aspergillosis is an infection seen in patients receiving intensive immunosuppressive regimens, such as transplant recipients. Some risk factors that increase the incidence of infection have been determined, and patients defined as having high risk are recommended to take antifungal prophylaxis and be monitored closely. Here, we present a liver transplant patient with mild respiratory symptoms and a normal chest radiography on day 26 posttransplant. However, he had acute renal failure and underwent hemodialysis, which are both defined to increase significantly the risk of aspergillosis. Although the radiographic scan was initially normal, thorax tomography and later bronchoscopy showed findings compatible with pulmonary aspergillosis, and the patient was started on antifungal treatment. The nonspecific mild symptoms and an initial normal radiology can make diagnosis of invasive fungal infections difficult; thus caution and close follow-up of high-risk patients should be performed.