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Coccidioidomycosis and heart transplantation
K A Hall1, G K Sethi, L J Rosado
1Section of Cardiovascular and Thoracic Surgery, University of Arizona, Tucson 85724.
Summary
Coccidioides immits infection (cocci) in heart transplant recipients did not impact survival rates. Prophylactic ketoconazole is recommended after initial cocci treatment to prevent recurrence.
Area of Science:
- Infectious Diseases
- Transplant Medicine
- Mycology
Background:
- Heart transplant recipients are susceptible to opportunistic infections.
- Coccidioides immits infection (cocci) is a significant fungal pathogen in endemic areas.
- Monitoring for cocci in immunocompromised patients is crucial.
Purpose of the Study:
- To investigate the incidence and clinical outcomes of Coccidioides immits infection in heart transplant recipients.
- To evaluate the impact of cocci on patient survival.
- To determine the efficacy of ketoconazole in preventing cocci recurrence.
Main Methods:
- Retrospective analysis of 199 heart transplant recipients.
- Documentation of cocci episodes through fungal cultures.
- Treatment with intravenous amphotericin B followed by oral ketoconazole.
- Comparison of survival rates between patients with and without cocci.
Main Results:
- Eleven episodes of cocci were documented in nine patients.
- Two recurrent cocci episodes occurred after discontinuation of ketoconazole maintenance.
- Actuarial survival at 1 and 5 years was identical in patients with and without cocci.
- Intravenous amphotericin B followed by oral ketoconazole was the treatment protocol.
Conclusions:
- Coccidioides immits infection does not appear to adversely affect early and late clinical outcomes in heart transplant recipients.
- Prophylactic use of ketoconazole or other oral antifungals is recommended after successful treatment of initial cocci infection to prevent recurrence.