title: Histoplasmosis after solid organ transplant.
abstract: BACKGROUND
  To improve our understanding of risk factors, management, diagnosis, and outcomes associated with histoplasmosis after solid organ transplant (SOT), we report a large series of histoplasmosis occurring after SOT.
  
  
  METHODS
  All cases of histoplasmosis in SOT recipients diagnosed between 1 January 2003 and 31 December 2010 at 24 institutions were identified. Demographic, clinical, and laboratory data were collected.
  
  
  RESULTS
  One hundred fifty-two cases were identified: kidney (51%), liver (16%), kidney/pancreas (14%), heart (9%), lung (5%), pancreas (2%), and other (2%). The median time from transplant to diagnosis was 27 months, but 34% were diagnosed in the first year after transplant. Twenty-eight percent of patients had severe disease (requiring intensive care unit admission); 81% had disseminated disease. Urine Histoplasma antigen detection was the most sensitive diagnostic method, positive in 132 of 142 patients (93%). An amphotericin formulation was administered initially to 73% of patients for a median duration of 2 weeks; step-down therapy with an azole was continued for a median duration of 12 months. Ten percent of patients died due to histoplasmosis with 72% of deaths occurring in the first month after diagnosis; older age and severe disease were risk factors for death from histoplasmosis. Relapse occurred in 6% of patients.
  
  
  CONCLUSIONS
  Although late cases occur, the first year after SOT is the period of highest risk for histoplasmosis. In patients who survive the first month after diagnosis, treatment with an amphotericin formulation followed by an azole for 12 months is usually successful, with only rare relapse.
authors.affiliation: Department of Internal Medicine, University of Kansas School of Medicine, Wichita.
authors.forename: Maha
authors.initials: M
authors.lastname: Assi
authors.forename: Stanley
authors.initials: S
authors.lastname: Martin
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Wheat
authors.forename: Chadi
authors.initials: C
authors.lastname: Hage
authors.forename: Alison
authors.initials: A
authors.lastname: Freifeld
authors.forename: Robin
authors.initials: R
authors.lastname: Avery
authors.forename: John W
authors.initials: JW
authors.lastname: Baddley
authors.forename: Paschalis
authors.initials: P
authors.lastname: Vergidis
authors.forename: Rachel
authors.initials: R
authors.lastname: Miller
authors.forename: David
authors.initials: D
authors.lastname: Andes
authors.forename: Jo-Anne H
authors.initials: JA
authors.lastname: Young
authors.forename: Kassem
authors.initials: K
authors.lastname: Hammoud
authors.forename: Shirish
authors.initials: S
authors.lastname: Huprikar
authors.forename: David
authors.initials: D
authors.lastname: McKinsey
authors.forename: Thein
authors.initials: T
authors.lastname: Myint
authors.forename: Julia
authors.initials: J
authors.lastname: Garcia-Diaz
authors.forename: Eden
authors.initials: E
authors.lastname: Esguerra
authors.forename: E J
authors.initials: EJ
authors.lastname: Kwak
authors.forename: Michele
authors.initials: M
authors.lastname: Morris
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Mullane
authors.forename: Vidhya
authors.initials: V
authors.lastname: Prakash
authors.forename: Steven D
authors.initials: SD
authors.lastname: Burdette
authors.forename: Mohammad
authors.initials: M
authors.lastname: Sandid
authors.forename: Jana
authors.initials: J
authors.lastname: Dickter
authors.forename: Darin
authors.initials: D
authors.lastname: Ostrander
authors.forename: Smyrna Abou
authors.initials: SA
authors.lastname: Antoun
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kaul
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006660:Histoplasmosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: fungal infection; histoplasmosis; solid organ transplant
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