title: A multicenter study of histoplasmosis and blastomycosis after solid organ transplantation.
abstract: OBJECTIVE
  A review of the clinical presentation, diagnosis, treatment and outcomes of 30 solid organ transplant recipients (SOTRs) with histoplasmosis or blastomycosis from 3 Midwestern academic medical centers.
  
  
  BACKGROUND
  The endemic fungal pathogens, Histoplasma capsulatum and Blastomyces dermatitidis, may cause severe infection in SOTRs. In this report, we describe the clinical presentation, diagnosis, treatment, and outcomes of these endemic fungal infections (EFIs) among SOTRs at 3 academic transplant centers.
  
  
  METHODS
  A retrospective review was conducted of SOTRs with histoplasmosis or blastomycosis from 3 Midwestern medical centers in the United States. Data collected included demographics, immunosuppression, clinical presentation, method of diagnosis, antifungal treatment, response to therapy, and patient and graft survival.
  
  
  RESULTS
  Between 1996 and 2008, 30 transplant recipients with histoplasmosis or blastomycosis were identified, giving a cumulative incidence of infection of 0.50% (30/5989); 73% of the study patients were renal transplant recipients, and the median time to disease onset after transplantation was 10.5 months. The lungs were the most common site of infection (83%), and 60% had disseminated disease. Urine antigen testing was positive in all patients in whom it was performed (23/23). Initial antifungal therapy consisted of amphotericin B in 70%, and 87% received azoles, typically itraconazole (83%). Two patients developed relapsed infection and 7 patients had graft failure after EFI. Overall mortality was 30%, with an attributable mortality of 13%.
  
  
  CONCLUSIONS
  As in several previous single-center studies, the incidence of post-transplant histoplasmosis and blastomycosis was <1%, but often resulted in disseminated infection. In this cohort, EFI was associated with a high rate of allograft loss and overall mortality.
authors.affiliation: Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois 60612, USA. sgrim@uic.edu
authors.forename: S A
authors.initials: SA
authors.lastname: Grim
authors.forename: L
authors.initials: L
authors.lastname: Proia
authors.forename: R
authors.initials: R
authors.lastname: Miller
authors.forename: M
authors.initials: M
authors.lastname: Alhyraba
authors.forename: A
authors.initials: A
authors.lastname: Costas-Chavarri
authors.forename: J
authors.initials: J
authors.lastname: Oberholzer
authors.forename: N M
authors.initials: NM
authors.lastname: Clark
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001758:Blastomyces / Q000302:isolation & purification*; D001759:Blastomycosis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006658:Histoplasma / Q000302:isolation & purification*; D006660:Histoplasmosis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D016377:Organ Transplantation / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents