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Published on: February 14, 2011
A multicenter study of histoplasmosis and blastomycosis after solid organ transplantation
1Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois 60612, USA. sgrim@uic.edu
Aim:
A review of the clinical presentation, diagnosis, treatment and outcomes of 30 solid organ transplant recipients (SOTRs) with histoplasmosis or blastomycosis from 3 Midwestern academic medical centers.
Background:
The endemic fungal pathogens, Histoplasma capsulatum and Blastomyces dermatitidis, may cause severe infection in SOTRs. In this report, we describe the clinical presentation, diagnosis, treatment, and outcomes of these endemic fungal infections (EFIs) among SOTRs at 3 academic transplant centers.
Methods:
A retrospective review was conducted of SOTRs with histoplasmosis or blastomycosis from 3 Midwestern medical centers in the United States. Data collected included demographics, immunosuppression, clinical presentation, method of diagnosis, antifungal treatment, response to therapy, and patient and graft survival.
Results:
Between 1996 and 2008, 30 transplant recipients with histoplasmosis or blastomycosis were identified, giving a cumulative incidence of infection of 0.50% (30/5989); 73% of the study patients were renal transplant recipients, and the median time to disease onset after transplantation was 10.5 months. The lungs were the most common site of infection (83%), and 60% had disseminated disease. Urine antigen testing was positive in all patients in whom it was performed (23/23). Initial antifungal therapy consisted of amphotericin B in 70%, and 87% received azoles, typically itraconazole (83%). Two patients developed relapsed infection and 7 patients had graft failure after EFI. Overall mortality was 30%, with an attributable mortality of 13%.
Conclusions:
As in several previous single-center studies, the incidence of post-transplant histoplasmosis and blastomycosis was <1%, but often resulted in disseminated infection. In this cohort, EFI was associated with a high rate of allograft loss and overall mortality.
Insights
Solid organ transplant recipients (SOTRs) with endemic fungal infections like histoplasmosis or blastomycosis face severe outcomes. These infections, though rare (<1%), frequently disseminate, leading to high mortality and graft loss in transplant patients.
Area of Science:
- Medical Mycology
- Transplant Infectious Diseases
- Immunocompromised Host Infections
Background:
- Endemic fungal pathogens Histoplasma capsulatum and Blastomyces dermatitidis can cause severe infections in solid organ transplant recipients (SOTRs).
- Understanding the clinical spectrum, diagnosis, treatment, and outcomes of these endemic fungal infections (EFIs) is crucial for managing SOTRs.
Purpose of the Study:
- To review the clinical presentation, diagnosis, treatment, and outcomes of histoplasmosis and blastomycosis in SOTRs.
- To analyze the incidence, risk factors, and consequences of these fungal infections in a multi-center transplant cohort.
Main Methods:
- Retrospective review of 30 SOTRs diagnosed with histoplasmosis or blastomycosis across three Midwestern academic medical centers.
- Data collection included patient demographics, immunosuppression details, clinical presentation, diagnostic methods, antifungal therapies, treatment response, and survival rates.
Main Results:
- The cumulative incidence of infection was 0.50% (30/5989), with renal transplant recipients being the most common (73%).
- Pulmonary involvement (83%) and disseminated disease (60%) were frequent, with positive urine antigen tests in all tested patients.
- High rates of allograft loss (7/30) and overall mortality (30%) were observed, with attributable mortality at 13%.
Conclusions:
- Post-transplant histoplasmosis and blastomycosis, while rare (<1%), often manifest as disseminated infections in SOTRs.
- These endemic fungal infections are associated with significant morbidity, including high rates of graft failure and mortality in solid organ transplant recipients.
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