Histoplasmosis in solid organ transplant recipients: early diagnosis and treatment.
OBJECTIVE
To present current knowledge about the epidemiology, clinical presentation, diagnosis and treatment of histoplasmosis in solid organ transplant (SOT) recipients.


RESULTS
Histoplasmosis is rare in SOT patients, and most cases have been reported from large transplant centers in the Midwestern USA, where the fungus is endemic. Urine antigen testing and the chest computed tomography scan are emerging as especially useful diagnostic tools in the SOT population. Standard treatments include liposomal amphotericin b followed by itraconazole, but newer azoles (voriconazole and posaconazole) have good in-vitro activity and have been successfully used in some SOT cases.


CONCLUSIONS
Clinical suspicion is essential to early recognition of histoplasmosis in SOT patients who often present with fever of unknown cause and pulmonary symptoms. Diagnosis is usually made by a combinatorial approach, including antigen tests, radiology and appropriate biopsies for culture and histology. Treatment with available antifungals is associated with more than 95% success.
Freifeld
Alison G
AG
University of Nebraska Medical Center, Omaha, 68198-5400, USA. afreifeld@unmc.edu
Wheat
L Joseph
LJ
Kaul
Daniel R
DR
D000935:Antifungal Agents / Q000627:therapeutic use*; D000946:Antigens, Fungal / Q000652:urine; D001706:Biopsy; D042241:Early Diagnosis; D005334:Fever / Q000382:microbiology; D006660:Histoplasmosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D009172:Mycology / Q000379:methods; D016377:Organ Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016482:Urinalysis
D000935:Antifungal Agents; D000946:Antigens, Fungal