The prevention of recrudescent coccidioidomycosis after solid organ transplantation

Janis E. Blair, Shimon Kusne, Elizabeth J. Carey, Raymond L. Heilman

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

BACKGROUND. Coccidioidomycosis is an endemic fungal infection of the southwestern United States that causes considerable morbidity and mortality in transplant recipients, often as the result of reactivated infection. METHODS. A retrospective review of the medical records of 47 patients with prior coccidioidomycosis who underwent solid organ transplantation (18 liver, 24 kidney, 3 pancreas, and 2 combined organ) at our tertiary care academic medical center. RESULTS. Of 47 transplant recipients with a history of coccidioidomycosis, 44 had quiescent infection at transplantation. Of the three with active coccidioidomycosis at transplantation, two were taking azole prophylaxis and had no further coccidioidal infection after transplantation. One of the three had positive serologic findings identified only on the day of transplantation, and prophylaxis was initiated a few hours after surgery along with immunosuppression; nevertheless, the treatment course was complicated by disseminated coccidioidomycosis. Seven patients did not initiate or self-discontinued prophylaxis; one patient who discontinued prophylaxis experienced recurrent pulmonary infection. CONCLUSIONS. For patients undergoing transplantation in an area endemic for coccidioidomycosis, we recommend routine evaluation for evidence of prior infection and initiation of azole prophylaxis. For our patients with quiescent infection, azoles suppressed any recrudescent coccidioidomycosis after transplantation. The selection of patients who would benefit from prophylaxis and the optimal dose and duration of such prophylaxis should be studied further.

Original languageEnglish (US)
Pages (from-to)1182-1187
Number of pages6
JournalTransplantation
Volume83
Issue number9
DOIs
StatePublished - May 2007

Fingerprint

Coccidioidomycosis
Organ Transplantation
Transplantation
Azoles
Infection
Southwestern United States
Mycoses
Tertiary Healthcare
Immunosuppression
Patient Selection
Medical Records
Pancreas
Morbidity
Kidney
Lung
Mortality
Liver

Keywords

  • Azole
  • Coccidioidomycosis
  • Dissemination
  • Fungal
  • Immunosuppression
  • Infection
  • Prophylaxis

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

The prevention of recrudescent coccidioidomycosis after solid organ transplantation. / Blair, Janis E.; Kusne, Shimon; Carey, Elizabeth J.; Heilman, Raymond L.

In: Transplantation, Vol. 83, No. 9, 05.2007, p. 1182-1187.

Research output: Contribution to journalArticle

Blair, Janis E. ; Kusne, Shimon ; Carey, Elizabeth J. ; Heilman, Raymond L. / The prevention of recrudescent coccidioidomycosis after solid organ transplantation. In: Transplantation. 2007 ; Vol. 83, No. 9. pp. 1182-1187.
@article{e00d8e1328944bdaae8efea163479a60,
title = "The prevention of recrudescent coccidioidomycosis after solid organ transplantation",
abstract = "BACKGROUND. Coccidioidomycosis is an endemic fungal infection of the southwestern United States that causes considerable morbidity and mortality in transplant recipients, often as the result of reactivated infection. METHODS. A retrospective review of the medical records of 47 patients with prior coccidioidomycosis who underwent solid organ transplantation (18 liver, 24 kidney, 3 pancreas, and 2 combined organ) at our tertiary care academic medical center. RESULTS. Of 47 transplant recipients with a history of coccidioidomycosis, 44 had quiescent infection at transplantation. Of the three with active coccidioidomycosis at transplantation, two were taking azole prophylaxis and had no further coccidioidal infection after transplantation. One of the three had positive serologic findings identified only on the day of transplantation, and prophylaxis was initiated a few hours after surgery along with immunosuppression; nevertheless, the treatment course was complicated by disseminated coccidioidomycosis. Seven patients did not initiate or self-discontinued prophylaxis; one patient who discontinued prophylaxis experienced recurrent pulmonary infection. CONCLUSIONS. For patients undergoing transplantation in an area endemic for coccidioidomycosis, we recommend routine evaluation for evidence of prior infection and initiation of azole prophylaxis. For our patients with quiescent infection, azoles suppressed any recrudescent coccidioidomycosis after transplantation. The selection of patients who would benefit from prophylaxis and the optimal dose and duration of such prophylaxis should be studied further.",
keywords = "Azole, Coccidioidomycosis, Dissemination, Fungal, Immunosuppression, Infection, Prophylaxis",
author = "Blair, {Janis E.} and Shimon Kusne and Carey, {Elizabeth J.} and Heilman, {Raymond L.}",
year = "2007",
month = "5",
doi = "10.1097/01.tp.0000260143.54103.0d",
language = "English (US)",
volume = "83",
pages = "1182--1187",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - The prevention of recrudescent coccidioidomycosis after solid organ transplantation

AU - Blair, Janis E.

AU - Kusne, Shimon

AU - Carey, Elizabeth J.

AU - Heilman, Raymond L.

PY - 2007/5

Y1 - 2007/5

N2 - BACKGROUND. Coccidioidomycosis is an endemic fungal infection of the southwestern United States that causes considerable morbidity and mortality in transplant recipients, often as the result of reactivated infection. METHODS. A retrospective review of the medical records of 47 patients with prior coccidioidomycosis who underwent solid organ transplantation (18 liver, 24 kidney, 3 pancreas, and 2 combined organ) at our tertiary care academic medical center. RESULTS. Of 47 transplant recipients with a history of coccidioidomycosis, 44 had quiescent infection at transplantation. Of the three with active coccidioidomycosis at transplantation, two were taking azole prophylaxis and had no further coccidioidal infection after transplantation. One of the three had positive serologic findings identified only on the day of transplantation, and prophylaxis was initiated a few hours after surgery along with immunosuppression; nevertheless, the treatment course was complicated by disseminated coccidioidomycosis. Seven patients did not initiate or self-discontinued prophylaxis; one patient who discontinued prophylaxis experienced recurrent pulmonary infection. CONCLUSIONS. For patients undergoing transplantation in an area endemic for coccidioidomycosis, we recommend routine evaluation for evidence of prior infection and initiation of azole prophylaxis. For our patients with quiescent infection, azoles suppressed any recrudescent coccidioidomycosis after transplantation. The selection of patients who would benefit from prophylaxis and the optimal dose and duration of such prophylaxis should be studied further.

AB - BACKGROUND. Coccidioidomycosis is an endemic fungal infection of the southwestern United States that causes considerable morbidity and mortality in transplant recipients, often as the result of reactivated infection. METHODS. A retrospective review of the medical records of 47 patients with prior coccidioidomycosis who underwent solid organ transplantation (18 liver, 24 kidney, 3 pancreas, and 2 combined organ) at our tertiary care academic medical center. RESULTS. Of 47 transplant recipients with a history of coccidioidomycosis, 44 had quiescent infection at transplantation. Of the three with active coccidioidomycosis at transplantation, two were taking azole prophylaxis and had no further coccidioidal infection after transplantation. One of the three had positive serologic findings identified only on the day of transplantation, and prophylaxis was initiated a few hours after surgery along with immunosuppression; nevertheless, the treatment course was complicated by disseminated coccidioidomycosis. Seven patients did not initiate or self-discontinued prophylaxis; one patient who discontinued prophylaxis experienced recurrent pulmonary infection. CONCLUSIONS. For patients undergoing transplantation in an area endemic for coccidioidomycosis, we recommend routine evaluation for evidence of prior infection and initiation of azole prophylaxis. For our patients with quiescent infection, azoles suppressed any recrudescent coccidioidomycosis after transplantation. The selection of patients who would benefit from prophylaxis and the optimal dose and duration of such prophylaxis should be studied further.

KW - Azole

KW - Coccidioidomycosis

KW - Dissemination

KW - Fungal

KW - Immunosuppression

KW - Infection

KW - Prophylaxis

UR - http://www.scopus.com/inward/record.url?scp=34248381705&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34248381705&partnerID=8YFLogxK

U2 - 10.1097/01.tp.0000260143.54103.0d

DO - 10.1097/01.tp.0000260143.54103.0d

M3 - Article

C2 - 17496533

AN - SCOPUS:34248381705

VL - 83

SP - 1182

EP - 1187

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 9

ER -