Screening Coccidioides serology in kidney transplant recipients: A 10‐year cross‐sectional analysis

Abstract

Pre-transplant serological screening for Coccidioides is recommended in kidney transplant candidates from endemic areas. We observed high seroprevalence among patients from highly and established endemic areas, for whom universal prophylaxis is recommended. For residents from less well-established areas of endemicity, serological screening showed benefit in identifying patients at risk. In patients with isolated EIA IgM, performing repeat and confirmatory tests is recommended. Patients from non-endemic areas had low risk of infection, however, a thorough social history is necessary to evaluate risk.

Coccidioidomycosis in solid organ transplant recipients

“…Pretransplant screening with EIA antibodies and chest imaging can be considered for transplant candidates who currently reside or have previously resided in endemic areas. Among transplant centers located in Coccidioides-endemic regions, rates of pretransplant seropositivity is reported from 1.4 to 5.6% [23][24][25]. However, it is important to note that antibody testing can become negative over time if exposure was remote.…”

Endemic Mycoses and Cryptococcus in Solid Organ Transplant Recipients

“…Pre-transplant screening with EIA antibodies is recommended for all individuals with current or prior residence in endemic areas [2]. Studies examining rates of pre-transplant seropositivity from transplant centers in endemic regions range from 1.4%-5.6% [19][20][21]. Interpretation of EIA results, particularly isolated IgM in an otherwise asymptomatic patient, can pose difficulty.…”

“…Follow-up testing 4-6 weeks later is recommended to determine if there is subsequent IgG seroconversion. Interpretation of negative serologies requires caution, as persistence of anti-coccidioidal antibodies is not lifelong, and remote infection with negative serology is possible [19]. Additionally, infection without a serological response can occur, and negative serology does not exclude coccidioidomycosis, particularly in immunocompromised patients [13,15].…”

“…The recommended dose of fluconazole for seropositive or recently infected patients is 400 mg per day (qday) for 12 months post-transplant with subsequent conversion to dose of 200-400 mg qday indefinitely, adjusted for renal insufficiency if needed. For patients who are seronegative but reside in highly endemic areas, fluconazole at a dose of 200 mg qday is recommended for at least 6-12 months, although at our center prophylaxis is continued indefinitely as long as they live within the endemic area [2,15,19,25].…”

Successful treatment of disseminated coccidioidomycosis with direct kidney allograft infection

“…Serologic testing pre-transplant has been suggested in endemic areas but is not routine and neither the recipient nor donor had this risk factor. 1 Disseminated coccidioidomycosis historically has a guarded prognosis and early diagnosis and treatment are essential. Genitourinary involvement by Coccidioides is welldescribed but direct infection of solid organ allografts is rare.…”