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Endemic fungal infections in solid organ and hematopoietic cell transplant recipients enrolled in the
C A Kauffman1, A G Freifeld, D R Andes
1University of Michigan and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
Background:
Invasive fungal infections are a major cause of morbidity and mortality among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients, but few data have been reported on the epidemiology of endemic fungal infections in these populations.
Methods:
Fifteen institutions belonging to the Transplant-Associated Infection Surveillance Network prospectively enrolled SOT and HCT recipients with histoplasmosis, blastomycosis, or coccidioidomycosis occurring between March 2001 and March 2006.
Results:
A total of 70 patients (64 SOT recipients and 6 HCT recipients) had infection with an endemic mycosis, including 52 with histoplasmosis, 9 with blastomycosis, and 9 with coccidioidomycosis. The 12-month cumulative incidence rate among SOT recipients for histoplasmosis was 0.102%. Occurrence of infection was bimodal; 28 (40%) infections occurred in the first 6 months post transplantation, and 24 (34%) occurred between 2 and 11 years post transplantation. Three patients were documented to have acquired infection from the donor organ. Seven SOT recipients with histoplasmosis and 3 with coccidioidomycosis died (16%); no HCT recipient died.
Conclusions:
This 5-year multicenter prospective surveillance study found that endemic mycoses occur uncommonly in SOT and HCT recipients, and that the period at risk extends for years after transplantation.
Insights
Endemic fungal infections like histoplasmosis are uncommon in solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients. The risk period for these infections extends for many years post-transplant.
Area of Science:
- Medical Mycology
- Transplant Infectious Diseases
- Epidemiology
Background:
- Invasive fungal infections pose significant risks to solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients.
- Limited data exist on the epidemiology of endemic fungal infections in these vulnerable patient groups.
Purpose of the Study:
- To investigate the incidence and characteristics of endemic mycoses in SOT and HCT recipients.
- To determine the at-risk period for endemic fungal infections following transplantation.
Main Methods:
- A 5-year prospective surveillance study (March 2001-March 2006) involving 15 institutions.
- Enrollment of SOT and HCT recipients diagnosed with histoplasmosis, blastomycosis, or coccidioidomycosis.
Main Results:
- 70 patients (64 SOT, 6 HCT) were identified with endemic mycoses.
- Histoplasmosis was the most common (52 cases), with a 12-month cumulative incidence of 0.102% in SOT recipients.
- Infections occurred bimodally, with peaks in the first 6 months and 2-11 years post-transplant; 3 infections were donor-derived.
- Mortality was 16% among SOT recipients (7 with histoplasmosis, 3 with coccidioidomycosis); no HCT recipients died.
Conclusions:
- Endemic mycoses are uncommon but serious infections in transplant recipients.
- The risk for these infections persists for years after transplantation, necessitating long-term surveillance.
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