Coccidioidomycosis among persons undergoing lung transplantation in the coccidioidal endemic region
AffiliationUniv Arizona, Coll Med, Div Pulm, Dept Med
Univ Arizona, Coll Med, Div Infect Dis, Dept Med
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CitationChaudhary, S, Meinke, L, Ateeli, H, Knox, KS, Raz, Y, Ampel, NM. Coccidioidomycosis among persons undergoing lung transplantation in the coccidioidal endemic region. Transpl Infect Dis. 2017; 19:e12713. https://doi.org/10.1111/tid.12713
JournalTRANSPLANT INFECTIOUS DISEASE
Rights© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
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AbstractBackground Coccidioidomycosis, an endemic fungal infection, is more likely to be symptomatic and severe among those receiving allogeneic transplants. While several case series have been published for various transplanted organs, none has described the incidence and outcomes in those receiving lung transplants within the coccidioidal endemic region. Methods Patients receiving a heart-lung, single-lung, or bilateral-lung transplantation at the University of Arizona between 1985 and 2009 were retrospectively reviewed. Results Coccidioidomycosis occurred post transplantation in 11 (5.8%) of 189 patients. All but one patient was diagnosed with pulmonary coccidioidomycosis and only one had a history of prior coccidioidomycosis. Two patients received transplants from donors found to have coccidioidomycosis at the time of transplantation and one death was directly attributed to coccidioidomycosis. The risk of developing active coccidioidomycosis was significantly higher if the patient did not receive some type of antifungal therapy post transplantation (P<.001). Conclusion Within the coccidioidal endemic region, post-transplantation coccidioidomycosis was a definable risk among lung transplant recipients. Use of antifungals appeared to reduce this incidence of disease. Almost all cases resulted in pulmonary disease, suggesting that the lung is the primary site of infection.
Note12 month embargo; published online: 28 April 2017
VersionFinal accepted manuscript