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Histoplasmosis in transplant recipients
Author(s) -
Gajurel Kiran,
Dhakal Reshika,
Deresinski Stan
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13087
Subject(s) - medicine , histoplasmosis , histoplasma , immunology , asymptomatic , pancytopenia , transplantation , fungemia , dimorphic fungus , aspergillosis , population , mycosis , bone marrow , genetics , environmental health , histoplasma capsulatum , biology , yeast
Abstract Histoplasma capsulatum is a dimorphic fungus that most often causes asymptomatic infection in the immunocompetent population. In immunocompromised patients, including solid organ transplant ( SOT ) and hematopoietic cell transplant ( HCT ) recipients, however, it is likely to cause severe life‐threatening infection. Post‐transplant histoplasmosis ( PTH ) in SOT is uncommon with an incidence of ≤1% and is even rarer in HCT patients. The majority of PTH in SOT is diagnosed in the first 2 years following transplantation. Histoplasmosis may result from endogenous reactivation of latent infection, de novo post‐transplant acquisition, and donor‐derived infection. Disseminated infection is common. Fever is the most common symptom and clinical features are often nonspecific, but patients with disseminated infection may present with a septic picture. Other features, including pancytopenia and hepatosplenomegaly, may not be prominent early in the course of illness. Contemporary histoplasma antigen assays are the most sensitive tests but cross‐reactivity with antigens of other fungi, including with Aspergillus galactomannan, is not uncommon. Treatment should be continued for at least a year. Histoplasma antigen levels have prognostic value and can be used to monitor the response to therapy. The attributable mortality is approximately 10%. Routine screening of donors and recipients is not currently recommended.