Genomic characterization of recurrent mold infections in thoracic transplant recipients

Transpl Infect Dis. 2018 Oct;20(5):e12935. doi: 10.1111/tid.12935. Epub 2018 Jun 19.


Invasive mold disease in thoracic organ transplant recipients is a well-recognized complication, but the long-term persistence of molds within the human body and evasion of host defenses has not been well-described. We present 2 cases of invasive mold disease (Verruconis gallopava and Aspergillus fumigatus) in thoracic transplant recipients who had the same mold cultured years prior to the invasive disease presentation. The paired isolates from the index and recurrent infections in both patients were compared using whole-genome sequencing to determine if the same strain of mold caused both the index and recurrent infections. In Case 1, the isolates were found to be of the same strain indicating that the initial colonizing isolate identified pre-transplant eventually caused invasive mold disease post-transplant while in Case 2, the 2 isolates were not of the same strain. These results demonstrate the distinct possibility of molds both persisting within the human body for years prior to invasive mold disease or the long-term risk of recurrent, persistent infection with more than one strain. Further studies of long-term molecular epidemiology of IMD and risk factors for mold persistence in transplant recipients are encouraged.

Keywords: Aspergillus fumigatus; Verruconis gallopava; Whole-genome sequencing; invasive mold disease; solid organ transplantation.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antifungal Agents / therapeutic use
  • Aspergillus fumigatus / genetics*
  • Aspergillus fumigatus / isolation & purification
  • Aspergillus fumigatus / pathogenicity
  • Biopsy
  • DNA, Fungal / genetics
  • Fatal Outcome
  • Heart Transplantation / adverse effects*
  • Humans
  • Invasive Fungal Infections / diagnosis
  • Invasive Fungal Infections / drug therapy
  • Invasive Fungal Infections / microbiology*
  • Invasive Fungal Infections / pathology
  • Lung Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Recurrence
  • Saccharomycetales / genetics*
  • Saccharomycetales / isolation & purification
  • Saccharomycetales / pathogenicity
  • Transplant Recipients
  • Whole Genome Sequencing


  • Antifungal Agents
  • DNA, Fungal