The prevention of recrudescent coccidioidomycosis after solid organ transplantation

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

Research output: Contribution to journalReview article

31 Scopus citations

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 1 2007

Keywords

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

ASJC Scopus subject areas

  • Transplantation

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