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Histoplasmosis in solid organ transplant recipients at a large Midwestern university transplant center

A G Freifeld1, P C Iwen, B L Lesiak

  • 1Section of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198-5400, USA. afreifeld@unmc.edu

Transplant Infectious Disease : an Official Journal of the Transplantation Society
|January 5, 2006
PubMed

Insights

Histoplasmosis, a fungal infection, is increasingly affecting solid organ transplant recipients in the Midwest. Early diagnosis using antigen tests and cultures is crucial for managing this severe condition in immunocompromised patients.

Area of Science:

  • Infectious Diseases
  • Transplant Medicine
  • Mycology

Background:

  • Histoplasma capsulatum infections are uncommon in solid organ transplant (SOT) patients at the University of Nebraska Medical Center (UNMC), located at the edge of the endemic region.
  • A recent 2.5-year period saw a significant increase in severe histoplasmosis cases among SOT patients at UNMC.

Purpose of the Study:

  • To describe the clinical presentation, diagnosis, and incidence of severe histoplasmosis in SOT patients at UNMC.
  • To highlight the rising rate of histoplasmosis in this patient population.

Main Methods:

  • Retrospective review of nine SOT patients diagnosed with histoplasmosis.
  • Analysis of clinical symptoms, diagnostic methods (culture, antigen tests), immunosuppressive regimens, and patient outcomes.
  • Comparison of incidence rates before and during the study period.

Main Results:

  • Nine SOT patients (6 renal/renal-pancreas, 3 liver) developed severe histoplasmosis, with symptom onset a median of 11 months post-transplant.
  • Common symptoms included prolonged fever, cough, shortness of breath, and fatigue; all had abnormal chest imaging.
  • Diagnosis was confirmed by culture in 8/9 patients, and serum/urine Histoplasma antigen tests were positive in all 9.
  • The incidence of clinical histoplasmosis among SOT patients at UNMC rose 17-fold from 0.11% (1997-2001) to 1.9% (2002-2004).

Conclusions:

  • Histoplasmosis can manifest as a prolonged febrile illness with subacute pulmonary symptoms in SOT patients, even without a regional outbreak.
  • The rising incidence underscores the importance of considering Histoplasma infection in SOT patients presenting with compatible symptoms, regardless of geographic location.
  • Prompt diagnosis via antigen testing and culture is vital for effective management of histoplasmosis in this vulnerable population.

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