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Adverse Occurrence type:
Rare. First known case report in lung recipient; only a few previous case reports of Sporothrix in kidney recipients and one possibly in a "thoracic" recipient (organ unknown).
Time to detection:
26 days for BAL to be positive for fungal cultures, symptomatic throughout complicated immediate post-operative course.
Alerting signals, symptoms, evidence of occurrence:
Symptomatic post-op with mucopurulent drainage and requiring continued mechanical ventilation and pressor support. BAL from postoperative day (POD) 2 had positive bacterial cultures and treated but symptoms didn't fully resolve, to include POD 12 had fever 102.3F and leukocytosis 25.4 cells/microL, intermittent fevers through POD 27 to 100.4. On POD 28, BAL fungal culture from POD 2 identified Sporothrix schenckii. Patient began improving after starting Amphotericin B lipid formulation POD 28, and after 30 days was switched to Itraconzaole oral solution.
Demonstration of imputability or root cause:
Recipient of bilateral single lung transplants from the same donor. Cultures taken from native lungs were negative. BAL from POD 2 grew Sporothrix schenckii at POD 28 where the patient had been incompletely responsive to treatment of multiple bacteria and candida culture results, but did recover after initiation of amphotericin B lipid formulation, later maintained after itraconazole oral solution. No known risk factors were identified in donor or recipient. Most likely source of the Sporothrix was the donor lungs given the short time frame between transplantation and the specimen growing the Sporothrix.
Suggest new keywords:
Sporothrix schenckii, lung transplantation
Respiratory Failure due to Possible Donor-Derived Sporothrix schenckii Infection in a Lung Transplant Recipient. Bahr et al. Case Rep Infect Dis. 2015;2015:925718
Add Sporothrix genus to the fungal taxonomy (EP) - ok