De novo coccidioidomycosis among solid organ transplant recipients 1 or more years after transplant

Asbury, Kara; Blair, Janis E.; August, Jessica; Beatty, Norman; Mi, Lanyu; Carey, Elizabeth J.; Huskey, Janna; LeMond, Lisa; Zangeneh, Tirdad T.

doi:10.1111/ajt.15324

Cited by 15 publications

(12 citation statements)

References 18 publications

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“…1 MiraVists Coccidioides EIA assay is utilized at our center as an alternative EIA test. 2 Antigen testing for Coccidioides Galactomannan and (1-3) Beta-d-glucan assay. * Samples for histopathology and culture of the appropriate site, and in severe cases, fungal blood cultures should be collected as well.…”

Section: Future Directionsmentioning

confidence: 99%

“…This is because post-transplant mortality has been reported to be as high as 63% in SOT recipients [4], while donor-derived infections have reported mortality rates of 28% [13,14]. While most of the literature has focused on reactivation or donor-derived cases of coccidioidomycosis in SOT recipients, we previously reported that 40.7% of SOT recipients experienced possible de novo pulmonary coccidioidomycosis as well, with 5.5% having an extrapulmonary disease, resulting in a mortality rate of 1.1% [2].…”

Section: Introductionmentioning

confidence: 96%

“…This is partly thought to be secondary to climate change, shifts in population with increased residence and travel to endemic areas, increased testing, and the availability of improved diagnostic tests [1]. While most infections are asymptomatic or mild, moderate to severe infection carries high morbidity and mortality, especially in immunocompromised patients, including in solid organ transplant (SOT) recipients [2][3][4]. It is thought that less than 5% of coccidioidomycosis cases in the general population progress to disseminated disease.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Approach to Coccidioidomycosis in Solid Organ Transplant Recipients

Zangeneh

Al-Obaidi

2023

JoF

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Coccidioidomycosis is a fungal infection endemic in the southwestern United States, Mexico, and parts of Central and South America. While coccidioidomycosis is associated with mostly mild infections in the general population, it can lead to devastating infections in immunocompromised patients, including solid organ transplant (SOT) recipients. Early and accurate diagnosis is important in achieving better clinical outcomes in immunocompromised patients. However, the diagnosis of coccidioidomycosis in SOT recipients can be challenging due to the limitations of diagnostic methods including cultures, serology, and other tests in providing a timely and accurate diagnosis. In this review, we will discuss the available diagnostic modalities and approaches when evaluating SOT recipients with coccidioidomycosis, from the use of conventional culture methods to serologic and molecular testing. Additionally, we will discuss the role of early diagnosis in assisting with the administration of effective antifungal therapy to reduce infectious complications. Finally, we will discuss ways to improve the performance of coccidioidomycosis diagnostic methods in SOT recipients with an option for a combined testing approach.

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Section: Future Directionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Diagnostic Approach to Coccidioidomycosis in Solid Organ Transplant Recipients

Zangeneh

Al-Obaidi

2023

JoF

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“…Coccidioidomycosis is a fungal infection endemic to the Southwestern United States, Mexico, and parts of Central and South America. It is caused by two genetically distinct species of soil-inhabiting molds, Coccidioides immitis and Coccidioides posadasii [ 1 ]. Coccidioidomycosis is associated with increased morbidity and mortality in immunocompromised hosts [ 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

The Utility of (1→3)-β-D-Glucan Testing in the Diagnosis of Coccidioidomycosis in Hospitalized Immunocompromised Patients

Al-Obaidi¹,

Ayazi²,

Shi³

et al. 2022

JoF

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Coccidioidomycosis is a fungal infection endemic to the Southwestern United States which is associated with high morbidity and mortality in immunocompromised hosts. Serology is the main diagnostic tool, although less sensitive among immunocompromised hosts. (1→3)-β-D-glucan (BDG) is a non-specific fungal diagnostic test that may identify suspected coccidioidomycosis and other invasive fungal infections. We retrospectively investigated the utility of BDG between 2017 and 2021 in immunocompromised hosts with positive Coccidioides spp. cultures at our institutions. During the study period, there were 368 patients with positive cultures for Coccidioides spp.; among those, 28 patients were immunocompromised hosts, had both Coccidioides serology and BDG results available, and met other inclusion and exclusion criteria. Half of the patients had positive Coccidioides serology, and 57% had a positive BDG ≥ 80 pg/mL. Twenty-three (82%) had at least one positive test during their hospitalization. Among immunocompromised hosts with suspicion for coccidioidomycosis, the combination of Coccidioides serology and BDG can be useful in the initial work up and the timely administration of appropriate antifungal therapy. However, both tests failed to diagnose many cases, underscoring the need for better diagnostic techniques for identifying coccidioidomycosis in this population.

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“…In addition to organ transplantation, risk factors for severe or disseminated coccidioidomycosis include African American race, Filipino ethnicity, HIV/AIDS, diabetes mellitus, and pregnancy [5,6,8,9]. The majority of disease occurs within the first year after transplantation and following treatment for acute rejection [3,5,10]. The reported mortality rate in SOT recipients who develop coccidioidomycosis is significantly high at 30-43% [1,11].…”

Section: Introductionmentioning

confidence: 99%

Coccidioidomycosis in solid organ transplant recipients

Nanayakkara

Blodget

2019

Current Opinion in Organ Transplantation

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Purpose of reviewThe purpose of the review is an update of diagnosis and treatment of coccidioidomycosis infection in solid organ transplant (SOT) patients. Endemic fungal infections continue to be a cause of serious morbidity and mortality in transplant recipients. Recent findingsIn transplant patients there are recommendations regarding screening in areas that are endemic for coccidioidomycosis. This screening involves serologic testing and chest imaging. In endemic areas pretransplant seropositivity varies from 1.4 to 5.6%. In immunocompromised patients with elevated complement fixation titers, evaluation of cerebrospinal fluid is recommended even in the absence of symptoms. Although coccidioidomycosis can be a self-limited disease in immunocompotent patients, all SOT patients should be treated regardless of severity. This may include intravenous amphotericin B in severe cases and fluconazole therapy in milder episodes. In those SOT recipients with evidence of prior coccidioidomycosis, lifelong secondary prophylaxis with fluconazole given risk of recurrent disease.

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De novo coccidioidomycosis among solid organ transplant recipients 1 or more years after transplant

Cited by 15 publications

References 18 publications

Diagnostic Approach to Coccidioidomycosis in Solid Organ Transplant Recipients

Diagnostic Approach to Coccidioidomycosis in Solid Organ Transplant Recipients

The Utility of (1→3)-β-D-Glucan Testing in the Diagnosis of Coccidioidomycosis in Hospitalized Immunocompromised Patients

Coccidioidomycosis in solid organ transplant recipients

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