Coccidioidomycosis in selected immunosuppressed hosts

Area of Science:

• Infectious Diseases
• Immunology
• Mycology

Background:

• Coccidioidomycosis poses severe risks, including disseminated infection and mortality, for immunocompromised individuals.
• Populations at risk include those with human immunodeficiency virus (HIV), transplant recipients, and those on biologic response modifiers.
• Understanding coccidioidomycosis in these vulnerable groups is crucial for effective management.

Purpose of the Study:

• To review clinical manifestations, diagnosis, treatment, and prevention of coccidioidomycosis in immunocompromised populations.
• To highlight the impact of HIV control and immune status on coccidioidomycosis severity.
• To define the risks and timing of coccidioidomycosis in transplant recipients and users of biologic agents.

Main Methods:

• Literature review of coccidioidomycosis in specific immunocompromised patient groups.
• Analysis of clinical data correlating HIV status (AIDS diagnosis, CD4 counts, HIV-RNA levels) with disease severity.
• Examination of coccidioidomycosis risk patterns in solid organ and hematopoietic stem cell transplant recipients.
• Assessment of coccidioidomycosis risk associated with biologic response modifiers, particularly TNF-α inhibitors.

Main Results:

• In HIV-infected individuals, AIDS diagnosis and CD4 counts <250 cells/μl correlate with severe coccidioidomycosis.
• Controlled HIV viremia and higher CD4 counts are associated with less severe disease.
• The highest risk for acute coccidioidomycosis in transplant recipients is 6-12 months post-transplant.
• Relapses can occur during immunosuppression without antifungal prophylaxis.
• Biologic agents, especially TNF-α inhibitors, may increase risk, but optimal prevention/treatment remain undefined.

Conclusions:

• Controlled HIV infection and improved cellular immunity significantly mitigate coccidioidomycosis severity.
• Transplant recipients face a distinct risk window for coccidioidomycosis post-transplantation.
• Further research is needed to establish best practices for preventing and treating coccidioidomycosis in patients receiving biologic agents.