FUNGAL SKIN INFECTION IN ORGAN TRANSPLANT RECIPIENTS – EPIDEMIOLOGY, DIAGNOSIS, AND TREATMENT

Introduction

Organ transplant recipients are susceptible to bacterial, viral, and fungal skin infections. The rates and timing of fungal infections in transplant recipients vary by the type of transplant. Even though most of these infections occur within the first six months of transplantation, patients with rejection episodes who are maintained on higher doses of immunosuppressants remain at risk after this period. T-cells and B-cells play a pivotal role in defending the body against invasive fungal infections, as supported by the spontaneous resolution of fungal lesions after discontinuation of immunosuppression. Antifungal prophylaxis and preemptive antifungal therapy in the early posttransplantation period in patients with suspicion of fungal infection may lead to an increase in fungal infections in the later posttransplant phase and to the emergence of unusual fungal pathogens that are less susceptible to standard antifungal agents. Overall, organ transplantation and the accompanying use of immunosuppressive agents call for a high index of suspicion for skin infections, appropriate biopsy and culture, and early aggressive therapy, because skin and soft-tissue infections in transplant recipients may be a sign or cause of systemic infection.

Despite the importance of skin and soft-tissue infection in transplant recipients, there is only limited data on the epidemiology and rate of fungal infections restricted to the skin in these patients.