title: Donor-derived organ transplant transmission of coccidioidomycosis.
abstract: Coccidioidomycosis in solid organ transplant recipients most often occurs as a result of primary infection or reactivation of latent infection. Herein, we report a series of cases of transplant-related transmission of coccidioidomycosis from a single donor from a non-endemic region whose organs were transplanted to 5 different recipients. In all, 3 of the 5 recipients developed evidence of Coccidioides infection, 2 of whom had disseminated disease. The degree of T-cell immunosuppression and timing of antifungal therapy initiation likely contributed to development of disease and disease severity in these recipients. This case series highlights the importance of having a high index of suspicion for Coccidioides infection in solid organ transplant recipients, even if the donor does not have known exposure, given the difficulties of obtaining a detailed and accurate travel history from next-of-kin.
authors.affiliation: Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Dierberg
authors.forename: K A
authors.initials: KA
authors.lastname: Marr
authors.forename: A
authors.initials: A
authors.lastname: Subramanian
authors.forename: H
authors.initials: H
authors.lastname: Nace
authors.forename: N
authors.initials: N
authors.lastname: Desai
authors.forename: J E
authors.initials: JE
authors.lastname: Locke
authors.forename: S
authors.initials: S
authors.lastname: Zhang
authors.forename: J
authors.initials: J
authors.lastname: Diaz
authors.forename: C
authors.initials: C
authors.lastname: Chamberlain
authors.forename: D
authors.initials: D
authors.lastname: Neofytos
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use*; D003045:Coccidioides / Q000302:isolation & purification*; D003047:Coccidioidomycosis / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*; D017809:Fatal Outcome; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D013601:T-Lymphocytes / Q000276:immunology; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D014195:Travel; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole