Coccidioidomycosis complicating solid organ transplantation

Area of Science:

• Mycology
• Transplant Infectious Diseases

Background:

• Coccidioidomycosis is the most frequent endemic mycosis causing disease in North American solid-organ transplant patients.
• Risk factors include underlying renal/liver disease, immunosuppression from antirejection drugs, and viral infections like cytomegalovirus.
• Approximately 50% of cases result from reactivation of prior infection, often within the first year post-transplant.

Purpose of the Study:

• To review the epidemiology, risk factors, diagnosis, and management of coccidioidomycosis in solid-organ transplant recipients.
• To highlight the importance of diagnostic tools and therapeutic strategies for this patient population.

Main Methods:

• Review of existing literature on coccidioidomycosis in solid-organ transplant patients.
• Analysis of diagnostic methods including serologic tests and bronchoscopy with culture.
• Summary of current therapeutic approaches and ongoing research in prophylaxis.

Main Results:

• Pulmonary symptoms are most common, despite a high rate of disseminated infection.
• Bronchoscopy with culture is a frequent diagnostic method.
• Serologic tests are valuable for identifying high-risk patients for reactivation.

Conclusions:

• Coccidioidomycosis poses a significant threat to solid-organ transplant recipients, with reactivation being common.
• Prompt diagnosis and treatment with amphotericin B or azoles are essential.
• Prophylactic strategies, including azole antifungals, are under investigation for at-risk individuals.