Coccidioidomycosis and lung transplantation

Coccidioidomycosis, an endemic fungal infection in the desert southwestern United States, causes substantial morbidity and mortality in immunocompromised hosts. Because lungs are the primary site of coccidioidal infection, lung transplant recipients in endemic areas remain particularly vulnerable. Moreover, direct airway communication to the environment, diminished cough reflex, impaired mucociliary clearance, altered alveolar macrophage function, and ischemic lung injury further enhances the risk of pulmonary infection after lung transplantation. Herein, we review available data on coccidioidomycosis in solid organ transplant recipients and candidates seeking transplantation, and propose strategies for screening, treatment, and prevention of coccidioidal infection in the lung transplant candidate.