title: Coccidioidomycosis Transmission Through Organ Transplantation: A Report of the OPTN Ad Hoc Disease Transmission Advisory Committee.
abstract: Donor-derived coccidioidomycosis has caused unexpected morbidity and mortality in transplant recipients. All proven or probable reports of donor-derived coccidioidomycosis to the Disease Transmission Advisory Committee between 2005 and August 2012 were reviewed. Six reports of proven or probable coccidioidomycosis were discovered. In four of six, the infection was first detected at autopsy in the recipient. In two cases it was first identified in the donor. Twenty-one recipients received organs from these six donors. Transmission occurred in 43% at a median of 30 days posttransplant with a mortality rate of 28.5%. Eleven recipients received preemptive antifungals, seven did not receive treatment, and treatment information was not reported for three recipients. Five of seven who did not receive prophylaxis/treatment died and all 11 who received early therapy survived. Six deaths occurred 14 to 55 days after transplant, with a median of 21 days. For exposed recipients, donor-derived coccidioidomycosis is a significant cause of morbidity and mortality. Evidence of infection in one recipient should prompt immediate evaluation for treatment of all other recipients from the same donor as preemptive treatment was effective. Further studies are needed to decide whether all donors from endemic areas should have routine serologic screening.
authors.affiliation: Division of Infectious Disease, Mayo Clinic in Arizona, Phoenix, AZ.
authors.forename: S
authors.initials: S
authors.lastname: Kusne
authors.affiliation: United Network for Organ Sharing, Richmond, VA.
authors.forename: S
authors.initials: S
authors.lastname: Taranto
authors.affiliation: United Network for Organ Sharing, Richmond, VA.
authors.forename: S
authors.initials: S
authors.lastname: Covington
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: D R
authors.initials: DR
authors.lastname: Kaul
authors.affiliation: Division of Infectious Disease, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: E A
authors.initials: EA
authors.lastname: Blumberg
authors.affiliation: Division of Transplant Infectious Disease, Duke University Medical Center, Durham, NC.
authors.forename: C
authors.initials: C
authors.lastname: Wolfe
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics and Surgery, University of Pittsburgh Medical School, Pittsburgh, PA.
authors.forename: M
authors.initials: M
authors.lastname: Green
mesh_terms: D026683:Advisory Committees; D003045:Coccidioides / Q000472:pathogenicity*; D003047:Coccidioidomycosis / Q000453:epidemiology / Q000209:etiology / Q000635:transmission*; D018562:Disease Transmission, Infectious; D046148:Donor Selection; D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects*; D061214:Patient Safety; D011379:Prognosis; D018570:Risk Assessment; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D066027:Transplant Recipients; D014481:United States / Q000453:epidemiology
keywords: antibiotic: antifungal; clinical research/practice; complication: infectious; donors and donation: donor-derived infections; fungal; infection and infectious agents; infectious disease