TY - GEN
T1 - Coccidioidomycosis in patients who have undergone transplantation
AU - Blair, Janis E.
PY - 2007/9
Y1 - 2007/9
N2 - In the early years of transplantation in Arizona, coccidioidomycosis occurred in 7% to 9% of recipients, with a mortality rate as high as 72% in some cases. In current transplant programs, however, evolution of immunosuppression and institution of targeted prophylaxis have resulted in coccidioidal infection rates ranging from 1% to 2%. The clinical characteristics of this infection among transplant recipients range from asymptomatic to fulminant and fatal. Dissemination is common, and mortality is high (28%). Because serologic response is often absent or slow, diagnosis can be challenging and often requires invasive diagnostic procedures. Pharmacologic treatment follows the guidelines of the Infectious Diseases Society of America, but control of infection may also dictate a decrease in immunosuppressant treatment. After infection is controlled, secondary azole prophylaxis is recommended to prevent relapse. Patients with a history of coccidioidomycosis may undergo successful transplantation when disease is inactive and azole prophylaxis is instituted. The incidence of donor-derived coccidioidomycosis is not known. The risk of coccidioidal infection among transplant recipients visiting in or relocating to an endemic area is low, and routine prophylaxis for this group is not recommended.
AB - In the early years of transplantation in Arizona, coccidioidomycosis occurred in 7% to 9% of recipients, with a mortality rate as high as 72% in some cases. In current transplant programs, however, evolution of immunosuppression and institution of targeted prophylaxis have resulted in coccidioidal infection rates ranging from 1% to 2%. The clinical characteristics of this infection among transplant recipients range from asymptomatic to fulminant and fatal. Dissemination is common, and mortality is high (28%). Because serologic response is often absent or slow, diagnosis can be challenging and often requires invasive diagnostic procedures. Pharmacologic treatment follows the guidelines of the Infectious Diseases Society of America, but control of infection may also dictate a decrease in immunosuppressant treatment. After infection is controlled, secondary azole prophylaxis is recommended to prevent relapse. Patients with a history of coccidioidomycosis may undergo successful transplantation when disease is inactive and azole prophylaxis is instituted. The incidence of donor-derived coccidioidomycosis is not known. The risk of coccidioidal infection among transplant recipients visiting in or relocating to an endemic area is low, and routine prophylaxis for this group is not recommended.
KW - Coccidioidomycosis
KW - Fungal infections
KW - Organ transplantation
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U2 - 10.1196/annals.1406.009
DO - 10.1196/annals.1406.009
M3 - Conference contribution
C2 - 17363431
AN - SCOPUS:35348901947
SN - 1573316881
SN - 9781573316880
T3 - Annals of the New York Academy of Sciences
SP - 365
EP - 376
BT - Coccidioidomycosis Sixth International Symposium
PB - Blackwell Publishing Inc.
ER -