Abstract
Histoplasmosis and blastomycosis are geographically restricted dimorphic fungi that cause infection after the conidia produced in the mold phase are inhaled into the lungs. In the lungs, at 37 °C, these organisms undergo transformation into the yeast phase. In transplant recipients, infection can occur by exposure to the mold in the environment, by reactivation of infection that had occurred previously and had been controlled by the host until immunosuppressive medications were given post-transplantation, and finally by transmission from the donor organ in the case of histoplasmosis. In transplant recipients, disseminated infection is common, and pulmonary infection is more likely to be severe than in a non-immunosuppressed person. Diagnosis has been improved, allowing earlier treatment, with the use of rapid antigen tests performed on serum and urine. Initial treatment, for all but the mildest cases of acute pulmonary histoplasmosis, should be with a lipid formulation of amphotericin B. After clinical improvement has occurred, step-down therapy with itraconazole is recommended for a total of 12 months for most transplant recipients, but some patients will require long-term suppressive therapy to prevent relapse of disease.
Highlights
Histoplasmosis and blastomycosis are not common infections among recipients of solid organ transplants, but in this population, these infections can be devastating [1,2,3,4]
Physicians who practice in those areas usually are cognizant of the clinical manifestations of infection with these fungi, but those who practice outside these areas may not think of or make the diagnosis of histoplasmosis or blastomycosis
The diagnosis is most straightforward in a patient who lives in an area endemic for these fungi and who presents with acute pulmonary infection
Summary
Histoplasmosis and blastomycosis are not common infections among recipients of solid organ transplants, but in this population, these infections can be devastating [1,2,3,4]. Physicians who practice in those areas usually are cognizant of the clinical manifestations of infection with these fungi, but those who practice outside these areas may not think of or make the diagnosis of histoplasmosis or blastomycosis. The diagnosis is most straightforward in a patient who lives in an area endemic for these fungi and who presents with acute pulmonary infection. The clinical picture may not be as clear, especially if they are living outside the area known to be endemic for these fungi. H. capsulatum and B. dermatitidis cause disease in healthy people, but in transplant recipients are more likely to cause severe disseminated infection. We will review the epidemiology, clinical manifestations, diagnosis, and treatment of histoplasmosis and blastomycosis in solid organ transplant recipients
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