Infections In Immunocompromised Persons Research Articles

Serratia marcescens isolated from newborn meningitis in the Iraqi city of Diwaniyah: Molecular characterization

Our study was conducted to detect virulence genes in Serratia marcescens. It has many virulence genes that cause nosocomal infections in immunocompromised persons and neonates. A total of 24/100 (24%) S. marcescens were obtained from neonates suffering from meningitis, and they were identified using culture characteristics biochemical- tests and confirmed by Polymerase chain reaction (PCR) technique, using the 16S rRNA gene. All virulence factors, including the fimA gene that encodes type-1 fimbria, the bsmB gene that encodes exo polysaccharide production, and ampC that encodes ß-lactamase enzymes, were done using the PCR technique. The results revealed that S. marcescens isolates have 16S rRNA gene at the percentage (100%), fimA gene at the percentage (54%), bsmB gene at the percentage (71%) and ampC gene at the percentage (100%). Finally, the DNA sequencing of (fimA, bsmB, and ampC genes) was done using a DNA sequencer technique to determine the sequence of nucleotides. The results revealed the similarities of the genes in local isolates of S. marcescens (98%) with S. marcescens isolates globally registered on the NCBI-Genbank website. Keywords: fimA gene, bsmB gene, ampC gene, Serratia marcescens, DNA sequences.

The pangenome structure of human pathogen Mycobacterium kansasii

The non-tuberculous Mycobacterium kansasii, is the causative agent of destructive pulmonary and extrapulmonary infections in immunocompromised persons. Incessant use of multiple antibiotics and lack of effective vaccines did little to combat M. kansasii mediated infections. Here, a bioinformatic analysis has been carried out using PanExplorer, to analyze the pangenome aimed at functional characterization of the bacterium, understanding it’s pathogenic lifestyle and recognize the factors shaping evolution and variations amongst strains. M. kansasii had a large core genome (60.2%), a small (11.9%) dispensable genome and 27.9% strain-specific genes. The core genome of M. kansasii had a high concentration of COGs (Cluster of orthologous genes) linked to energy production and conversion, amino acid transport and metabolism, nucleotide transport and metabolism, coenzyme transport and metabolism, and secondary me-tabolite biosynthesis, transport and metabolism. Interestingly, numerous genes within the core and dispensable genome were associated with pathogenesis and virulence. Noteworthy among them were type VII secretion, ESX, PP and PPE family proteins. Although, M. kansasii genomes revealed overall relatedness and conservation, genomic rearrangements caused variability within the strains. The information from this analysis could assist future microbial genomics research on M. kansasii, and further studies, e.g., concerning distinctive gene clusters, and evolution.

Prevalence and Antibiogram of Rothia mucilaginosa and Staphylococcus spp Isolated from Oral Cavity of Students in a Tertiary Institution

Bacteremia and systemic infection caused by Rothia mucilaginosa and Staphylococcus spp are uncommon and their resistance to antibiotics are becoming overwhelming. Hence, this study was carried out to investigate the prevalence and antibiogram of Rothia mucilaginosa and Staphylococcus spp from oral cavity of students in a Tertiary Institution. A total of fifty (50) specimen were collected from the oral cavity of male and female students in Rivers State University and subjected to standard microbiological procedures such as culturing, isolation, identification as well as antibiotic susceptibility test. Sixty-seven (67) bacterial isolates were identified with Staphylococcus aureus 43(64.2%) occurring most, followed by Rothia mucilaginosa 18(26.7%) and Staphylococcus epidermidis 6(8.9%). All the isolates of Rothia mucilaginosa, Staphylococcus aureus and Staphylococcus epidermidis were positive for the presence of haemolysin and catalase enzymes. The results of the percentage occurrence among male and female students revealed that Staphylococcus aureus had the highest occurrence (64.18%:59.38%) followed closely by Rothia mucilaginosa (22.86%:31.25%) while Staphylococcus epidermidis had the least prevalence (8.95%:9.37%) in male and female respectively. The result of the susceptibility patterns showed that majority of Staphylococcus aureus, Staphylococcus epidermidis and Rothia mucilaginosa were highly sensitive to ciprofloxacin (90.70%; 100%; 83.33%) and gentamicin (76.74%; 83.33%: 100%), and highly resistant to azithromycin (44.19% and 66.67%) for Staphylococcus aureus, Staphylococcus epidermidis and Rothia mucilaginosa were highly resistant to ampiclox (61.11%). The results of multiple antibiotic resistance (MAR) indices, showed that 86.05% of S. aureus; 83.33% of R. mucilaginosa and 100% of S. epidermidis had MAR indices ≥ 0.2. This study displays serious threat to public health because these microorganisms which showed some virulent factors such as production of haemolysin and catalase enzymes may cause life threatening infections in immunocompromised persons. The indiscriminate use of antibiotics to prevent increased antimicrobial resistance is advocated.

Immunobiology and Host Response to HEV.

Hepatitis E virus (HEV) usually causes acute self-limiting hepatitis but sometimes leads to chronic infection in immunocompromised persons. HEV is not directly cytopathic. Immunologically mediated events after HEV infection are believed to play important roles in the pathogenesis and clearance of infection. The anti-HEV antibody responses have been largely clarified since the determination of major antigenic determinant of HEV, which is located in the C-terminal portion of ORF2. This major antigenic determinant also forms the conformational neutralization epitopes. Robust anti-HEV immunoglobulin M (IgM) and IgG responses usually develop 3-4weeks after infection in experimentally infected nonhuman primates. In humans, potent specific IgM and IgG responses occur in the very early phase of the disease and are critical in eliminating the virus, in concert with the innate and adaptive T-cell immune responses. Testing anti-HEV IgM is valuable in the diagnosis of acute hepatitis E. The long-term persistence and protection of anti-HEV IgG provide the basis for estimating the prevalence of HEV infection and for the development of a hepatitis E vaccine. Although human HEV has four genotypes, all the viral strains are considered to belong to a single serotype. It is becoming increasingly clear that the innate and adaptive T-cell immune responses play critical roles in the clearance of the virus. Potent and multispecific CD4+ and CD8+ T cell responses to the ORF2 protein occur in patients with acute hepatitis E, and weaker HEV-specific CD4+ and CD8+ T cell responses appear to be associated with chronic hepatitis E in immunocompromised individuals.

Similarities, differences, and possible interactions between hepatitis E and hepatitis C viruses: Relevance for research and clinical practice.

Hepatitis E virus (HEV) and hepatitis C virus (HCV) are both RNA viruses with a tropism for liver parenchyma but are also capable of extrahepatic manifestations. Hepatitis E is usually a viral acute fecal-oral transmitted and self-limiting disease presenting with malaise, jaundice, nausea and vomiting. Rarely, HEV causes a chronic infection in immunocompromised persons and severe fulminant hepatitis in pregnant women. Parenteral HCV infection is typically asymptomatic for decades until chronic complications, such as cirrhosis and cancer, occur. Despite being two very different viruses in terms of phylogenetic and clinical presentations, HEV and HCV show many similarities regarding possible transmission through organ transplantation and blood transfusion, pathogenesis (production of antinuclear antibodies and cryoglobulins) and response to treatment with some direct-acting antiviral drugs. Although both HEV and HCV are well studied individually, there is a lack of knowledge about coinfection and its consequences. The aim of this review is to analyze current literature by evaluating original articles and case reports and to hypothesize some interactions that can be useful for research and clinical practice.

The Repurposing of the Antimalaria Drug, Primaquine, as a Photosensitizer to Inactivate Cryptococcal Cells

Cryptococcal cells can manifest skin infections in immunocompromised persons. While it may be easy to diagnose cryptococcal infection, treatment often fails due to the ineffectiveness of current antifungal agents. To this end, the present study explored the repurposing of primaquine (PQ), as a photosensitizer. PDT was carried out using a germicidal ultraviolet (UV) lamp, which has a radiation output of approximately 625 µW/cm2 at a distance of 20 cm. When compared to the non-treated cells, the metabolic activity of cryptococcal cells was significantly (p < 0.05) limited. The photolytic products of PQ were observed to alter the ultrastructure of treated cells. The latter was not incidental, as the same cells were also documented to lose their selective permeability. Importantly, PDT also improved the efficiency of macrophages to kill internalized cryptococcal cells (p ≤ 0.05) when compared to non-treated macrophages. Equally importantly, PDT was not detrimental to macrophages, as their metabolic activity was not significantly (p > 0.05) limited, even when exposed to 20× the MIC (determined for cryptococcal cells) and an exposure time that was 4× longer. Taken together, the results suggest PQ has the potential to control the growth of cryptococcal cells and limit their survival inside the macrophage.

Epstein-Barr virus (EBV) hyperimmune globulin isolated from donors with high gp350 antibody titers protect humanized mice from challenge with EBV

Primary infection with Epstein-Barr virus (EBV) is associated with post-transplant lymphoproliferative disease and severe disease in patients with X-linked lymphoproliferative disease; no therapies are approved to prevent EBV infection in these patients. Hyperimmune globulin has been used to prevent some virus infections in immunocompromised persons. Here, we identified plasma donors with high titers of EBV gp350 and EBV B cell neutralizing antibodies. Pooled IgG isolated from these donors was compared to intravenous immunoglobulin (IVIG) for its ability to reduce viral load in the blood in humanized mice challenged with EBV. Mice that received EBV hyperimmune globulin had significantly reduced EBV DNA copy numbers compared to animals that received saline control; however, while animals that received EBV hyperimmune globulin had lower EBV DNA copies than those that received IVIG, the difference was not significant. Thus, while EBV hyperimmune globulin reduced viral load compared to IVIG, the effect was modest.

Prevalence and Risk Factors for Lymphocytic Choriomeningitis Virus Infection in Continental Croatian Regions.

Lymphocytic choriomeningitis virus (LCMV) is a neglected human pathogen associated with aseptic meningitis, severe systemic infections in immunocompromised persons, and congenital anomalies. Data on the prevalence of LCMV infections are scarce. We analyzed the seroprevalence of LCMV in continental Croatian regions. A total of 338 serum samples of professionally exposed (forestry workers, hunters, agriculture workers in contact with rodents) and non-exposed populations (general population, pregnant women) were tested for the presence of LCMV antibodies using indirect immunofluorescence assay. No participants reported recent febrile disease. LCMV IgG antibodies were detected in 23/6.8% of participants: 9.8% exposed persons and 5.1% non-exposed persons (6.1% in the general population and 3.9% in pregnant women). No participants were LCMV IgM positive. Although higher seropositivity was found in males compared to females (8.9% vs. 4.7%), inhabitants of suburban/rural areas compared to inhabitants of urban areas (9.2% vs. 4.6%), and persons who used well as a source of water compared to those who used tap (11.4% vs. 5.6%), these differences did not reach statistical significance. Results of logistic regression showed that the presence of rodents in the house/yard and cleaning rodent nests were associated with an elevated risk for LCMV infection (OR = 2.962, 95% CI = 1.019–8.607).

English

BACKGROUND Pseudomonas aeruginosa is an opportunistic pathogen involved in a variety of nosocomial infections like pneumonia, bacteraemia, wound infection and urinary tract infection. It is also involved in infections of rigorous burns and infections in immunocompromised persons. This study was undertaken to determine the prevalence and antibiotic susceptibility patterns of pathogenic P. aeruginosa isolated from a variety of clinical specimens in a tertiary care hospital of Jamshedpur, Jharkhand, India. METHODS Pseudomonas aeruginosa was identified using standard methods from various clinical samples collected over a period of seven months. This was a descriptive cross-sectional study which was approved by the ethical committee. The study was conducted from January 2019 to January 2020 in the Department of Microbiology at MGM Medical College, Jamshedpur, Jharkhand, India. This hospital has ICUs, one emergency ward, surgical & medical wards and Out-Patient Departments. RESULTS Our study showed the prevalence of P. aeruginosa during the study period from January 2019 to January 2020 in the Department of Microbiology at MGM Medical College, Jamshedpur, Jharkhand, India. A total of 1389 clinical samples were aerobically cultured, out of which 758 (54.6 %) yielded significant growth and the rest 630 (45.4 %) samples were either sterile or showed non-significant growth. From 758 positive growth samples, 161 (21.20 %) P. aeruginosa were isolated CONCLUSIONS The high prevalence of P. aeruginosa as an opportunistic nosocomial pathogen and high frequency of antimicrobial resistance among the clinical isolates demand regular monitoring of antibiogram of P. aeruginosa isolates with proper implementation of antimicrobial policy. Antibiotics should be used appropriately with care. Antimicrobial therapy should not be started unless there is clear evidence of infection and infection to be handled with proper infection control measures. KEYWORDS Pseudomonas aeruginosa, Pus Samples, Antimicrobial Resistance

Possible Diagnostic Delays and Missed Prevention Opportunities in Pneumocystis Pneumonia Patients Without HIV: Analysis of Commercial Insurance Claims Data-United States, 2011-2015.

Pneumocystis pneumonia (PCP) is a life-threatening but treatable and preventable fungal infection in immunocompromised persons. Previous studies suggest that persons without HIV who develop PCP (PCPHIV-) experience more acute, severe illness than persons with HIV who develop PCP (PCPHIV+). We analyzed health insurance claims data to compare demographics, underlying conditions, symptoms, and prescriptions for PCPHIV+ and PCPHIV-. We used the IBM MarketScan Research Databases to identify patients diagnosed with PCP during 2011-2015. We analyzed claims 1 year before to 3 months after diagnosis to compare PCPHIV+ and PCPHIV-. Among 3938 patients, 70.4% were PCPHIV-. Compared with PCPHIV+, PCPHIV- were more likely to be older (median, 60 vs 45 years; P < .0001), female (51.5% vs 20.2%; P < .0001), hypoxemic (13.5% vs 7.1%; P < .0001), and to die within 90 days (6.6% vs 4.2%; P < .0001). The most common underlying conditions among PCPHIV- included chronic pulmonary diseases (54.6%), solid tumors (35.1%), hematologic malignancies (20.1%), and rheumatologic conditions (14.0%). The median time between the first visit for PCP-related symptoms and PCP diagnosis was longer for PCPHIV- than PCPHIV+ (25 vs 16 days; P < .0001). In the 3 months before PCP diagnosis, PCPHIV- were less likely to have an outpatient prescription for PCP prophylaxis than PCPHIV+ (6.9% vs 10.6%; P = .0001). PCPHIV- may experience a prolonged illness course and diagnostic delays compared with PCPHIV+. Clinicians should maintain a high index of suspicion for PCP in immunocompromised patients with compatible symptoms, regardless of HIV status.

Toxoplasma gondii infection in slaughtered pigs and cattle in Poland: seroprevalence, molecular detection and characterization of parasites in meat

BackgroundToxoplasma gondii infection may pose a severe medical problem especially in a congenital form and as an acquired infection in immunocompromised persons. Raw and undercooked meat of slaughtered animals is regarded as an important source of parasite infection; however, data concerning this issue in Poland are still insufficient. The aim of this study was to estimate the prevalence of T. gondii infection in pigs and cattle slaughtered for human consumption in Poland using serological and molecular methods.MethodsSera of 3111 pigs and 2411 cattle from 16 regions (voivodeships) of the country were examined for the presence of anti-T. gondii IgG using the direct agglutination test (DAT). Pepsin-digested samples of diaphragm and heart of seropositive animals were examined for the presence of T. gondii DNA (B1 gene) by nested PCR and real-time PCR, while non-digested samples were only examined by nested PCR. The B1 gene DNA samples were genotyped at 11 genetic markers using multilocus nested PCR-RFLP (Mn-PCR-RFLP) and sequencing.ResultsSeropositive DAT results were found in 11.9% of pigs and 13.0% of cattle. The highest seroprevalence was found in pigs from Podkarpackie (32.6%) and in cattle from Mazowieckie (44.6%). Data analysis showed that cattle > 5–10 years-old, as well as cattle and pigs from small farms, and pigs from farms with open production systems, had higher odds of testing seropositive (P < 0.05). Among the examined tissue samples, positive PCR results were found in samples from 12.2% and 10.2% of seropositive pigs and cattle, respectively. Among the samples successfully genotyped by Mn-PCR-RFLP and sequenced, four samples were identified as T. gondii type II and one sample as type I.ConclusionsThe presence of T. gondii antibodies in a substantial proportion of examined pigs and cattle as well as the detection of parasite DNA in their tissues highlight a potential health risk to the consumers in Poland.

Pseudomonas aeruginosa a common opportunistic pathogen in Jordan: A review article.

Pseudomonas aeruginosa is widely present in many diverse environments. It can be found in various living sources, including water, plants, intestinal tract of human and animals, and most importantly hospital environment. The organism is an important cause of nosocomial infections, such as septicemia and pneumonia, life-threatening infections in immunocompromised persons, and chronic infections in cystic fibrosis patients. Recent studies reported that hospitalized patients infected with multidrug resistance (MDR) P. aeruginosa have increased hospital length of stay and mortality. This short review focus on the current common occurrence and antimicrobial susceptibility pattern of P. aeruginosa in Jordan.

Resolution of a Chikungunya Outbreak in a Prospective Cohort, Cebu, Philippines, 2012-2014.

To the Editor: Chikungunya is a reemerging, mosquitoborne infectious disease caused by chikungunya virus (CHIKV). Its classic manifestations include fever and joint inflammation, which can develop into chronic joint disease. Infections in immunocompromised persons can lead to severe organ involvement and death. Chikungunya outbreaks appear to occur in 2 patterns: 1) spatially and temporally restricted outbreaks in endemic areas (1,2); and 2) large epidemics that occur periodically every 40–50 years affecting multiple geographic areas (3). The mechanisms associated with the initiation of these large outbreaks are not well understood. An A226V amino acid substitution in the virus envelope, which enhances replication in Aedes albopictus, a mosquito vector for CHIKV, and expansion of vectors into areas with previously immunologically naive populations are thought to be responsible for some recent epidemics (4). In chikungunya-endemic areas, environmental factors such as changes in rainfall and vector densities have been implicated in smaller scale outbreaks. The mechanisms underlying outbreak resolution are not well understood. Herd immunity afforded by exposed persons might play an important role in preventing ongoing virus transmission. Reported seroprevalence rates in affected areas have ranged from 10% to ≈40% after an outbreak (5–7).

PERIVENTRICULAR LEUKOMALACIA IN A PRETERM NEONATE WITH EARLY ONSET CAPNOCYTOPHAGA SEPSIS

Capnocytophaga sputigena is a slow-growing, capnophilic, gram negative, anaerobic, fusiform bacilli residing in oropharyngeal cavity of mammals. In humans, it causes localized periodontal infections and sporadic invasive infections in immunocompromised persons. Infrequently, it does cause chorioamnionitis and perinatal infections and is generally of lower morbidity risk in fetus and neonates. We describe a rare case report of early-onset neonatal Capnocytophaga sepsis with culture negative meningitis in preterm infant who developed early cystic periventricular leukomalacia in second week of life. Though neonatal Capnocytophaga infection is probably under-reported due to its fastidious nature and subclinical infection in mother, this case reminds that Capnocytophaga may be responsible for some occult cases of early neonatal septicemia, and that the organism may be more virulent in premature neonates with possibility of development of periventricular leukomalacia and neurological morbidities. Key words: Capnocytophaga species, Neonatal Infection, Periventricular Leukomalacia

Bacteriological study of coagulase positive staphylococci from urine in some akoko communities, ondo state, nigeria

Staphylococci which can be normal skin flora as well as aetiologic agent was examined for their clinical implications from urine sources during the study. The occurrence of staphylococcal species in urine sources of some people in Akoko communities between age group 5 to 55 years was determined. 50 sample sources were screened for this purpose. The total viable bacterial count of urine sample sources range from 0, 1 x 103 cfu/ml and 4 x 103 cfu/ml from Ikun-Akoko, Supare community, Iwaro-Akoko as well as Akungba-Akoko respectively to high microbial load of 50 x 106 cfu/ml from Supare-Akoko. The bacterial isolates were identified using standard microbiological techniques including biochemical characteristics in which 23 (46%) were coagulase positive and 25 (50%) were coagulase negative and 2 (4%) show no growth on Mannitol Salt Agar. The 48 isolates obtained for this study were all Gram positive cocci (Bacteria). The Staphylococcal species obtained were grouped as C.P.S a 1:- Coagulase positive Staphylococcus aureus group 1, C.P.S.a 2:- Coagulase positive Staphylococcus aureus group 2, C.NS 1; Coagulase negative Staphylococcus group 1, C.N.S 2: Coagulase negative Staphylococcus group 2 and C.N.S 3: Coagulase negative Staphylococcus group 3. Some of the isolates tested show multiple antibiotic resistance which is significant clinically in case of treatment of infections in immunocompromised persons. The physico-chemical properties of urine samples collected from the Akoko communities studied was determined using Combi 9 strip/kit. This study will help to generate a database for health management purposes with the aim of controlling Staphylococcus infections. Â

The protozoan pathogen Toxoplasma gondii targets the paracellular pathway to invade the intestinal epithelium

Abstract Toxoplasma gondii is a ubiquitous parasite found within all mammals and birds worldwide that can cause fatal infections in immunocompromised persons and fetuses. The parasite causes chronic infections by residing in long-living tissues of the muscle and brain. T. gondii infects the host through contaminated meat and water consumption with the gastrointestinal tract (GI tract) being the first point of contact with the host. The mechanisms by which the parasite invades the host through the GI tract are unknown, although it has been suggested that the paracellular pathway is important for parasite dissemination. Studies indicate that epithelial tight junction-associated proteins are affected by T. gondii, although which junctional proteins are affected and the nature of host protein-parasite interactions have not been established. We have uncovered evidence that T. gondii influences the cellular distribution of occludin to transmigrate the intestinal epithelium and suggest how candidate binding partners can be identified.

Virulence factors in Pseudomonas aeruginosa: mechanisms and modes of regulation

Pseudomonas aeruginosa is a bacterium responsible for severe nosocomial infections, life-threatening infections in immunocompromised persons, and chronic infections in cystic fibrosis patients. The bacterium's virulence depends on a large number of cell-associated and extracellular factors. The virulence factors play an important pathological role in the colonization, the survival of the bacteria and the invasion of tissues. There are two types of virulence factors: (1) factors involved in the acute infection: these factors are either on the surface of P.aeruginosa, either secreted. The pili allow adherence to the epithelium. The exoenzyme S and other adhesins reinforce the adherence to epithelial cells. The exotoxin A is responsible of tissue necrosis. Phospholipase C is a thermolabile haemolysin. The pathogenic role of exoenzyme S is attributable to the disruption of normal cytoskeletal organization, the destruction of immunoglobulin G and A, leads to depolymerization of actin filaments and contributes to the resistance to macrophages. P.aeruginosa produces at least four proteases causing bleeding and tissue necrosis; (2) factors involved in the chronic infection: siderophores (pyoverdin and pyochelin), allow the bacteria to multiply in the absence of ferrous ions. The strains isolated from patients with cystic fibrosis have a pseudocapsule of alginate that protects the bacterium from phagocytosis, dehydration and antibiotics. Moreover, it improves adherence to epithelial cells forming a biofilm. Two different types of regulation systems control the expression of the majority of these virulence factors: the two-component transcriptional regulatory system and the quorum sensing system. These two mechanisms are necessary to the survival and the proliferation of this microorganism in the host.

A CORD BLOOD TRANSPLANT RECIPIENT WITH MYCOBACTERIUM MUCOGENICUM CENTRAL VENOUS CATHETER INFECTION AFTER INFUSION OF TAP WATER

Mycobacterium mucogenicum is an unusual cause of central venous catheter and wound infections in immunocompromised persons. The organism is often found in drinking water and is resistant to many disinfectants. We report a cord blood transplant recipient who developed a central venous catheter infection after the patient herself had flushed her catheter with tap water. The infection was successfully treated by removal of the central venous catheter and administration of antimicrobial therapy.

Glycoprotein D adjuvant herpes simplex virus vaccine

Herpes simplex virus (HSV) Type-1 and -2 are common infections that can cause primary and recurrent herpes labialis and genitalis, as well as gingivostomatitis, keratoconjunctivitis, encephalitis, disseminated infections in immunocompromised persons and neonatal infections. Despite several decades of HSV vaccine development, no effective vaccine has been developed until recently. The following review of the genital HSV-2 glycoprotein D (gD2t, t is for truncated) subunit vaccine formulated with a new adjuvant (AS04) containing alum and 3-O deacylated monophosphoryl lipid A (MPL) provides a background in which to evaluate the vaccine as well as a brief review of other approaches to herpes vaccines. The gD2t-AS04 vaccine has been demonstrated to be safe in several large clinical trials. In two trials, the vaccine reduced genital herpes disease by 73 and 74%, but only in females with no previous HSV infection. A large ongoing trial in HSV seronegative females will provide additional data on protection from HSV disease and infection.

Coccidioidomycosis in hematopoietic stem cell transplant recipients

Coccidioidomycosis is an endemic fungal infection of the desert southwestern United States that can cause devastating disseminated infection in immunocompromised persons. Clinical coccidioidomycosis, which is caused by Coccidioides species, has been well characterized in patients who have had solid organ transplants, but it has rarely been described in patients who have received a hematopoietic stem cell transplant (HSCT). We report the experience of 121 consecutive HSCT recipients at a single tertiary care institution in an endemic area. One patient had fatal disseminated coccidioidomycosis after receiving an allogeneic transplant, and 2 patients had pulmonary infection before successful autologous HSCT; 1 of these 2 had a reactivation of coccidioidal infection after HSCT but was treated and survived. Coccidioidomycosis was not commonly identified in HSCT recipients, even in the endemic area. A prospective evaluation is required to address the optimal use of coccidioidal serologic tests, antifungal protocols, and secondary prophylaxis in these patients.