Abstract
Coccidioidomycosis is an endemic fungal infection of the southwestern United States. Normally a self-limited infection in healthy hosts, coccidioidomycosis can become a serious complication in patients who have had solid organ transplantation. Among patients whose solid organ transplantation was complicated by coccidioidomycosis, the infection has a variety of clinical presentations. Disseminated disease is common and has substantial morbidity. Patients at risk for coccidioidal infection should be identified so that antifungal prophylactic therapy can be initiated. Treatment options include amphotericin B or azoles. Secondary prophylaxis is recommended because relapse is frequent.
Highlights
A review of the medical literature was conducted to summarize the reports of transplant recipients whose posttransplantation courses were complicated by coccidioidomycosis
Secondary prophylactic therapy is recommended because relapse is frequent
Many questions persist regarding coccidioidomycosis in transplantation; future studies should refine screening, prophylactic therapy, and treatment for these patients
Summary
Coccidioidomycosis is an endemic fungal infection of the southwestern United States. A self-limited infection in healthy hosts, coccidioidomycosis can become a serious complication in patients who have had solid organ transplantation. Among patients whose solid organ transplantation was complicated by coccidioidomycosis, the infection has a variety of clinical presentations. Risk factors for disseminated disease include diabetes mellitus, pregnancy, male sex, race with dark pigmentation (African American, Filipino, Hispanic, and others), and immunodeficiency (such as HIV infection or organ transplantation) [1, 2]. In 1971, the death of a child due to disseminated coccidioidomycosis after renal transplantation prompted Murphey et al [4] to recommend that potential transplantation candidates with any evidence of prior coccidioidal infection should be excluded. Other authors have reiterated similar ideas [5] Despite these concerns, solid organ transplantation has flourished in locations of high endemicity for coccidioidomycosis. We review the current literature from a few transplant centers on coccidioidomycosis and solid organ transplantation
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