Coccidioidomycosis in Solid Organ Transplantation

Abstract

Coccidioidomycosis is an endemic fungal infection of the southwestern United States. Normally a self-limited infection in healthy hosts, coccidioidomycosis can become a serious complication in patients who have had solid organ transplantation. Among patients whose solid organ transplantation was complicated by coccidioidomycosis, the infection has a variety of clinical presentations. Disseminated disease is common and has substantial morbidity. Patients at risk for coccidioidal infection should be identified so that antifungal prophylactic therapy can be initiated. Treatment options include amphotericin B or azoles. Secondary prophylaxis is recommended because relapse is frequent.

Transmission of Tropical and Geographically Restricted Infections during Solid-Organ Transplantation

“…The importance of prophylaxis in these patients has been demonstrated in different studies (35,126).…”

“…Coccidioidomycoses complicating the postoperative course of renal, heart/heart-lung, liver, or small bowel transplant recipients have been reported (32,34,35,43,249,368,405).…”

“…In a few cases, brief visits to areas of endemicity had been sufficient for the infection to be acquired (35).…”

“…Coccidioidomycosis after SOT can occur at any time, but the period associated with the highest risk is the first year posttransplantation: 70% of cases develop in this period, with 50% occurring during the first 3 months (35). Overall mortality was 60% to 72% for the first cases described (86), but recent reports indicate that mortality has been lower than in earlier years, ranging from 0 to 33% (33,154).…”

Fungal Infections in Transplant and Oncology Patients

“…B. dermatitidis pneumonia was frequently complicated by acute respiratory distress syndrome and accordingly, high mortality (67%) [63]. Even in endemic regions, C. immitus infection is rarely encountered in the HSCT population [64] and most descriptions are in SOT recipients [65]. Unfortunately, as with the other endemic mycoses in the immunosuppressed population, dissemination is common, mortality is high (up to 72%), and infection can be transmitted via donated organs [66].…”