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Coccidioidomycosis in Patients Who Have Undergone Transplantation
Author(s) -
BLAIR JANIS E.
Publication year - 2007
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1196/annals.1406.009
Subject(s) - medicine , fulminant , asymptomatic , immunosuppression , transplantation , serology , incidence (geometry) , disease , intensive care medicine , surgery , immunology , antibody , physics , optics
: 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.