Coccidioidomycosis in Liver Transplant in an Endemic Area
Coccidioidomycosis is caused by dimorphic fungi of Coccidioides species, which are endemic in certain parts of Southwestern United States, Northern Mexico, Central America and South America. Extrapulmonary infection occurs in 1–5% of individuals with known coccidioidomycosis. Immunosuppressed patients, such as patients with human immunodeficiency viral infection, solid organ transplant recipients and patients treated with corticosteroids or tumor necrosis factor antagonists, are at increased risk for coccidioidomycosis and severe or disseminated disease.
In the endemic area of the Southwestern United States, the incidence of coccidioidomycosis in solid organ transplant recipients ranges from 1.4% to 6.9%. Identified risk factors for active coccidioidomycosis in this patient population include a pretransplantation history of coccidioidomycosis, serologic findings positive for coccidioidomycosis at transplantation and use of high-dose corticosteroids for treatment of acute cellular rejection. Some reports have suggested that targeted antifungal prophylaxis in solid organ transplant recipients may decrease the incidence of coccidioidomycosis. Several cases of donor-related transmission of coccidioidomycosis have been documented.
The aim of this study was to update previous observations regarding coccidioidomycosis that we had reported early in the experience of the solid organ transplantation program at our institution. Specifically, we sought to determine the incidence of coccidioidomycosis among liver transplant recipients, to assess the efficacy of current prophylaxis and treatment regimens and to identify potential risk factors of coccidioidal infection after liver transplantation.