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Histoplasmosis in solid organ transplant recipients: early diagnosis and treatment

Alison G Freifeld1, L Joseph Wheat, Daniel R Kaul

  • 1University of Nebraska Medical Center, Omaha, 68198-5400, USA. afreifeld@unmc.edu

Current Opinion in Organ Transplantation
|October 9, 2009
PubMed
Abstract

Insights

Histoplasmosis is rare in solid organ transplant (SOT) recipients, often presenting with fever. Early diagnosis using antigen tests and imaging, followed by antifungal treatment, leads to over 95% success.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Transplant Medicine

Background:

  • Histoplasmosis is a fungal infection caused by Histoplasma capsulatum.
  • Solid organ transplant (SOT) recipients are at risk for opportunistic infections.
  • Geographic location, particularly the Midwestern USA, is a key factor in endemicity.

Purpose of the Study:

  • To review current knowledge on histoplasmosis in SOT recipients.
  • To cover epidemiology, clinical presentation, diagnosis, and treatment.
  • To highlight challenges and advancements in managing this infection.

Main Methods:

  • Review of current literature on histoplasmosis in SOT patients.
  • Analysis of diagnostic modalities including antigen testing and imaging.
  • Evaluation of standard and emerging antifungal treatments.

Main Results:

  • Histoplasmosis is uncommon in SOT patients, with most cases reported from endemic areas.
  • Urine antigen testing and chest CT scans are valuable diagnostic tools.
  • Standard treatment involves liposomal amphotericin B followed by itraconazole; newer azoles show promise.

Conclusions:

  • High clinical suspicion is crucial for early detection in SOT recipients.
  • Diagnosis relies on a combination of antigen tests, radiology, and histopathology.
  • Antifungal therapy achieves over 95% treatment success in SOT patients.

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