Diagnostic Approach to Coccidioidomycosis in Solid Organ Transplant Recipients

Zangeneh, Tirdad T.; Al-Obaidi, Mohanad

doi:10.3390/jof9050513

Cited by 4 publications

(1 citation statement)

References 56 publications

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“…Targets for Coccidioides-specific PCRs include ITS regions [98,99], Antigen 2 and Proline Rich Antigen [100]. Variable sensitivities (74-100%) have been reported on respiratory, fresh and FFPE tissue and CSF samples [101]. The GeneSTAT.MDx Coccidioides (DxNA LLC, St. George, UT, USA) was one FDA-approved PCR, with 100% sensitivity and 93.8-100% specificity; however, it is no longer marketed [102].…”

Section: Endemic Mycosesmentioning

confidence: 99%

Molecular Diagnostics for Invasive Fungal Diseases: Current and Future Approaches

Pham,

Sivalingam,

Tang

et al. 2024

JoF

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Invasive fungal diseases (IFDs) comprise a growing healthcare burden, especially given the expanding population of immunocompromised hosts. Early diagnosis of IFDs is required to optimise therapy with antifungals, especially in the setting of rising rates of antifungal resistance. Molecular techniques including nucleic acid amplification tests and whole genome sequencing have potential to offer utility in overcoming limitations with traditional phenotypic testing. However, standardisation of methodology and interpretations of these assays is an ongoing undertaking. The utility of targeted Aspergillus detection has been well-defined, with progress in investigations into the role of targeted assays for Candida, Pneumocystis, Cryptococcus, the Mucorales and endemic mycoses. Likewise, whilst broad-range polymerase chain reaction assays have been in use for some time, pathology stewardship and optimising diagnostic yield is a continuing exercise. As costs decrease, there is also now increased access and experience with whole genome sequencing, including metagenomic sequencing, which offers unparalleled resolution especially in the investigations of potential outbreaks. However, their role in routine diagnostic use remains uncommon and standardisation of techniques and workflow are required for wider implementation.

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Section: Endemic Mycosesmentioning

confidence: 99%

Molecular Diagnostics for Invasive Fungal Diseases: Current and Future Approaches

Pham,

Sivalingam,

Tang

et al. 2024

JoF

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The dog as a sentinel and animal model for coccidioidomycosis

Ferguson,

Thompson,

Bruyette

et al. 2023

Medical Mycology

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Coccidioidomycosis is a potentially fatal fungal disease of humans and animals that follows inhalation of Coccidioides spp. arthroconidia in the environment. The disease in dogs resembles that in people, and because dogs may be at increased risk of exposure due to their proximity to the ground and digging behavior, they are valuable models for the disease in humans. Dogs have been sentinels for identification of new regions of endemicity in Washington and Texas. Canine serosurveillance has also been used to predict variables associated with environmental presence of Coccidioides spp. Expansion of the endemic region of coccidioidomycosis with climate change—along with predicted population increases and increased development in the southwest United States—may result in 45.4 million additional people at risk of infection by 2090. Here we provide an overview of the value of dogs as sentinels for the disease and encourage the routine reporting of coccidioidomycosis cases in dogs to public health agencies. We also highlight the value of dogs as naturally-occurring models for studying novel treatment options and preventatives, such as a novel live avirulent coccidioidomycosis vaccine.

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Clinical Characteristics and Mortality Risks Among Patients With Culture-Proven Coccidioidomycosis Who Are Critically Ill: A Multicenter Study in an Endemic Region

Lim,

Scott,

Wig

et al. 2024

Open Forum Infectious Diseases

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Background Coccidioidomycosis is an endemic mycosis in the southwestern United States. While most infections are mild, severe cases can be devastating. We aimed to describe clinical characteristics and the mortality risks of intensive care unit (ICU) patients with culture-proven coccidioidomycosis. Methods We performed a retrospective chart review of ICU patients with positive Coccidioides spp. culture in a large healthcare system in Arizona between October 1, 2017, and July 1, 2022. All data was entered in REDCap. Results One-hundred and forty-five patients were identified and included. The median age was 51 years, with the majority (69%) male and 39% non-Hispanic White. Most, 104 (72%) had pulmonary coccidioidomycosis, and 41 patients had extrapulmonary disease (17 meningitis, 13 fungemia, 10 musculoskeletal disease, and 4 pericardial or aortic involvement). Seventy (48%) patients died during hospitalization, and most patients (91%) received antifungal therapy during hospitalization. In the multivariate logistic regression model, Age ≥60 (OR 7.0, 95%CI 2.6 - 18.8), cirrhosis (OR 13.1, 95%CI 1.6 - 108.8), and mechanical ventilation or vasopressor support (OR 15.4, 95% CI 3.9 - 59.6) were independently associated with increased all-cause mortality, but pre-ICU antifungal use had statistically insignificant mortality risk association (OR 0.5, 95% CI 0.2 -1.2). Conclusions In our study of ICU coccidioidomycosis patients with multiple comorbidities, the mortality rate was high. Older age, cirrhosis, and mechanical ventilation or vasopressor support were significantly associated with high mortality. Future studies to evaluate those risk factors and the efficacy of rapid diagnosis and early therapy in high-risk patients are recommended.

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Diagnostic Approach to Coccidioidomycosis in Solid Organ Transplant Recipients

Cited by 4 publications

References 56 publications

Molecular Diagnostics for Invasive Fungal Diseases: Current and Future Approaches

Molecular Diagnostics for Invasive Fungal Diseases: Current and Future Approaches

The dog as a sentinel and animal model for coccidioidomycosis

Clinical Characteristics and Mortality Risks Among Patients With Culture-Proven Coccidioidomycosis Who Are Critically Ill: A Multicenter Study in an Endemic Region

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