Coccidioidomycosis in transplant recipients: a primer for clinicians in nonendemic areas.
OBJECTIVE
Coccidioidomycosis is a fungal infection caused by Coccidioides spp., a fungus endemic to the southwestern USA. Immunocompromised patients with coccidioidomycosis often present with atypical manifestations. We provide clinical, diagnostic, and management approaches for clinicians in nonendemic areas who might encounter coccidioidomycosis in transplant recipients.


RESULTS
With preemptive screening, heightened awareness, and targeted prophylaxis, the incidence of coccidioidomycosis in transplant recipients has decreased to 1-3% in endemic areas. Dissemination and mortality continues to be clinically significant (about 30%). Serological findings are often unreliable in transplant recipients, necessitating invasive procedures for a tissue or microbiological diagnosis. Management recommendations are similar to those for immunocompetent hosts, except that transplant patients may require more prolonged therapy and secondary prophylaxis to prevent reactivation. The exact risk of donor-derived coccidioidomycosis is unknown. Routine antifungal prophylaxis is not currently recommended for transplant recipients visiting or relocating to endemic areas.


CONCLUSIONS
Transplant recipients who travel to or reside part-time or full-time in endemic areas are at risk for both primary and reactivated coccidioidomycosis. Clinicians in nonendemic areas should be aware that early diagnosis followed by prompt antifungal therapy could be lifesaving. Prophylactic strategies can prevent reactivation in select circumstances.
Vikram
Holenarasipur R
HR
Mayo Clinic Hospital, Phoenix, Arizona 85054, USA. vikram.hr@mayo.edu
Blair
Janis E
JE
D000935:Antifungal Agents / Q000627:therapeutic use; D003047:Coccidioidomycosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D042241:Early Diagnosis; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D009172:Mycology / Q000379:methods; D016377:Organ Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D055502:Secondary Prevention; D014057:Tomography, X-Ray Computed; D014195:Travel; D016896:Treatment Outcome
D000935:Antifungal Agents; D007166:Immunosuppressive Agents