Histoplasmosis in kidney transplant recipients

Histoplasma capsulatum var. capsulatum is a thermally dimorphic fungus endemic in regions like the Midwestern USA, Africa, and Central/South America. It grows as a mold in the environment and as yeast in human tissues. The disease's severity and presentation depend mostly on the host's immunity. In immunocompromised individuals, it often causes progressive disseminated histoplasmosis (PDH), a severe systemic condition. PDH symptoms include pneumonia, enlarged spleen and liver, enteritis, pancytopenia, lymphadenopathy, skin and mucosal lesions, and joint pain, making the diagnosis a challenge. Though more described in Acquired Immunodeficiency Syndrome (AIDS) patients, PDH can also occur in kidney transplant (KT) recipients, although it is rare even in endemic areas. It can also complicate with acute kidney injury (AKI), graft loss, disease recurrence, hemophagocytic lymphohistiocytosis, and treatment toxicity. This review summarizes key aspects of PDH, including its epidemiology, pathophysiology, clinical and laboratorial features, diagnostic approaches, acute kidney injury, treatment options and prophylaxis among KT recipients with histoplasmosis.