Expert group opinion for diagnosis and management of fungal infections in solid organ transplant recipients in South Asia

Fungal infections, are common in solid organ transplant (SOT) recipients in South Asia. Invasive fungal infections (IFI) are the third-most common cause of infections in SOT recipients in South Asia after urinary tract infection and tuberculosis and are a significant cause of morbidity and mortality in this population. There are multiple factors, which lead to poor outcomes of these patients, i.e., lack of awareness, inadequate training of physicians, poor laboratory support to diagnose these infections, and sometimes nonavailability of appropriate antifungal agents to treat these infections. Among the IFI in India, invasive candidiasis is the most common followed by mucormycosis, invasive aspergillosis, and cryptococcosis. There is an increasing prevalence of azole resistance and multi-drug resistance among candida infections in South Asia. There are drug interactions of azoles with tacrolimus, cyclosporine, and everolimus and this must be kept in mind when treating various fungal infections. Another challenge is, how to screen and treat the donors and recipients before accepting them for transplant and subsequent management of transplant recipients. The most common endemic mycoses in the Asia-Pacific region are histoplasmosis caused by Histoplasma capsulatum, talaromycosis caused by Talaromyces marneffei and sporotrichosis caused by Sporothrix schenckii. The endemic fungal infections should be kept in the differential diagnosis of pyrexia of unknown origin in transplant recipients. Finally, the outcomes of these patients can be improved by increasing awareness among transplant physicians, better and wider availability of diagnostic facilities, and appropriate use of antifungal agents to treat these infections.