Multi‐organ failure caused by reactivated coccidioidomycosis without dissemination in a patient with renal transplantation

Myung, Jae Kyung; Jung, Saera; Bahng, Hye Seung; Lim, Chae Man; Han, Duck Jong; Woo, Jun Hee; Koh, Yoon Seok

doi:10.1046/j.1440-1843.2000.00232.x

Cited by 21 publications

(17 citation statements)

References 11 publications

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“…However, specific groups, such as Filipinos and African Americans, have a markedly increased risk of severe disease and dissemination. 73,74 HIV-infected persons, [6][7][8][9][10][11][12][13][14][15][75][76][77][78][79][80][81][82] organ transplant recipients, 16,17,[19][20][21][22][83][84][85] other immunocompromised patients, 23,[86][87][88][89][90][91][92] and pregnant women 82,93-97 also have an increased risk of severe disease and dissemination.…”

Section: Host Factorsmentioning

confidence: 99%

Coccidioidomycosis: A review and update

DiCaudo

2006

Journal of the American Academy of Dermatology

112

104

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Section: Host Factorsmentioning

confidence: 99%

Coccidioidomycosis: A review and update

DiCaudo

2006

Journal of the American Academy of Dermatology

112

104

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“…Most of the patients in whom coccidioidomycosis was diagnosed outside an area of endemicity were residents or former residents of an area of endemicity. In a few cases, brief visits were adequate for the infection to be acquired [11,13,30].…”

Section: Demographicsmentioning

confidence: 99%

“…Retrospective case series from areas of endemicity identified less dramatic cases of coccidioidomycosis, often limited to the lungs. Patients with pulmonary infection presented variably, some with an acute illness consisting of fever, productive cough, shortness of breath, altered sensorium, or fulminant respiratory failure with septic shock [30]. Other patients presented more insidiously, with anorexia, weight loss, fatigue, and the absence of fever or pulmonary symptoms.…”

Section: Clinical Characteristicsmentioning

confidence: 99%

Coccidioidomycosis in Solid Organ Transplantation

Blair¹,

Logan²

2001

CLIN INFECT DIS

197

228

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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.

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“…The medical literature indicates that reactivation of latent C. immitis infection likely represents the majority of coccidioidomycosis posttransplant cases, primarily occurring in patients who have resided in or visited these areas (2,3). In fact, some transplant centers in endemic areas test potential organ recipients for C. immitis serology and prophylactically treat those with a positive result or a past history of coccidioidal infection (1).…”

Section: Case Reportmentioning

confidence: 99%

Posttransplantation Disseminated Coccidioidomycosis Acquired from Donor Lungs

Miller

Hendren²,

Gilligan

2004

J Clin Microbiol

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A North Carolinian developed fatal coccidioidomycosis immediately after bilateral lung transplantation. The donor had previously traveled to Mexico, and the recipient had no travel history to an area where Coccidioides immitis is endemic. Immunosuppresive therapy of the transplant recipient likely reactivated latent Coccidioides infection in the donor lungs, leading to posttransplant coccidioidomycosis. CASE REPORTA 61-year-old North Carolina resident with chronic obstructive pulmonary disease and emphysema received a bilateral lung transplant. Subsequent immunosuppressive therapy included methylprednisone, azathioprine, and cyclosporine. During hospitalization, the patient also received cefuroxime, clindamycin, piperacillin-tazobactam, and acyclovir as prophylaxis, but no antifungal prophylaxis was initiated. Posttransplantation, the patient was poorly responsive and had complications, including coagulopathy, hypotension, and hypoxia, resulting in increased oxygen requirements. Laboratory findings were consistent with liver, pancreas, and kidney dysfunction, and the patient ultimately required hemodialysis. Chest X-ray images during the first postoperative week indicated bilateral diffuse pulmonary opacities consistent with edema or infection.At 2 weeks posttransplantation, cerebrospinal fluid (CSF) was obtained. CSF analysis showed Ͻ1 red blood cell/mm 3 and 1 total nucleated cell/mm 3 (22% lymphocytes, 63% monocytes, 15% other cells). The CSF contained 32 mg of protein/dl (normal, 15 to 45 mg/dl). A glucose level determination was not performed. The Gram stain showed no polymorphonuclear leukocytes and no organisms. The CSF culture was reported as no growth at 7 days, and peripheral blood cultures were negative after 5 days of incubation. Bronchial washings from the donor lungs at the time of transplantation grew oxacillin-susceptible Staphylococcus aureus. Stenotrophomonas maltophilia and coagulase-negative Staphylococcus spp. were recovered from subsequent washings. The patient's chest X-ray images showed persistent bilateral infiltrates and worsening alveolar consolidation.During the third week posttransplantation, chest X-ray images demonstrated extensive, progressive bilateral air space and interstitial opacities, as well as bilateral apical and lateral pleural thickening. In addition, a brain magnetic resonance image showed multiple areas of enhancement in the region of the gray-white matter junction thought to be consistent with a fungal infection. The patient had multiple line-drawn blood cultures positive with Candida parapsilosis. Further, a KOH preparation of the patient's bronchial washing showed budding yeast with pseudohyphae, and the Gram stain showed polymorphonuclear leukocytes and yeast. Interestingly, this culture not only grew Candida and S. maltophilia but also Coccidioides immitis. In less than 1 month postoperatively, the patient died, and an autopsy was performed.

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Multi‐organ failure caused by reactivated coccidioidomycosis without dissemination in a patient with renal transplantation

Abstract: Coccidioidomycosis should be included in the differential diagnosis of acute sepsis, particularly in an immunocompromised host who has travelled in an endemic area.

Cited by 21 publications

References 11 publications

Coccidioidomycosis: A review and update

Coccidioidomycosis: A review and update

Coccidioidomycosis in Solid Organ Transplantation

Posttransplantation Disseminated Coccidioidomycosis Acquired from Donor Lungs

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