Abstract
Endemic fungi are thermally dimorphic and occur naturally in specific geographic areas. Histoplasmosis, coccidioidomycosis, and blastomycosis are the three major disease entities encountered in North America. Even in endemic areas, disease incidence is low among transplant recipients. Infection is typically acquired via inhalation of molds from the environment. Disseminated infection is more likely to occur in immunocompromised individuals. Definitive diagnosis is established by growing the organism from respiratory secretions, blood, other body fluids, or tissue. With appropriate stains, fungal organisms may be detected directly from clinical specimens. All immunocompromised patients should be treated, usually with a lipid formulation of amphotericin B followed by azole therapy. Donors and recipients should be evaluated for the possibility of active disease before transplantation. Because each endemic fungal infection is unusual outside of a specific geographic area, a careful travel and residence history should be obtained.
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References
Pappas PG, Alexander BD, Andes DR, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis. 2010;50(8):1101–11.
Kontoyiannis DP, Marr KA, Park BJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis. 2010;50(8):1091–100.
Cuellar-Rodriguez J, Avery RK, Lard M, et al. Histoplasmosis in solid organ transplant recipients: 10 years of experience at a large transplant center in an endemic area. Clin Infect Dis. 2009;49(5):710–6.
Vail GM, Young RS, Wheat LJ, et al. Incidence of histoplasmosis following allogeneic bone marrow transplant or solid organ transplant in a hyperendemic area. Transpl Infect Dis. 2002;4(3):148–51.
Wheat LJ, Smith EJ, Sathapatayavongs B, et al. Histoplasmosis in renal allograft recipients. Two large urban outbreaks. Arch Intern Med. 1983;143(4):703–7.
Straub M, Schwarz J. The healed primary complex in histoplasmosis. Am J Clin Pathol. 1955;25(7):727–41.
Limaye AP, Connolly PA, Sagar M, et al. Transmission of Histoplasma capsulatum by organ transplantation. N Engl J Med. 2000;343(16):1163–6.
Freifeld AG, Iwen PC, Lesiak BL, et al. Histoplasmosis in solid organ transplant recipients at a large Midwestern university transplant center. Transpl Infect Dis. 2005;7(3–4):109–15.
Singh N, Lortholary O, Alexander BD, et al. An immune reconstitution syndrome-like illness associated with Cryptococcus neoformans infection in organ transplant recipients. Clin Infect Dis. 2005;40(12):1756–61.
Singh N, Perfect JR. Immune reconstitution syndrome associated with opportunistic mycoses. Lancet Infect Dis. 2007;7(6):395–401.
Vetter E, Torgerson C, Feuker A, et al. Comparison of the BACTEC MYCO/F lytic bottle to the isolator tube, BACTEC plus aerobic F/bottle, and BACTEC anaerobic lytic/10 bottle and comparison of the BACTEC plus aerobic F/bottle to the isolator tube for recovery of bacteria, mycobacteria, and fungi from blood. J Clin Microbiol. 2001;39(12):4380–6.
Hage CA, Ribes JA, Wengenack NL, et al. A multicenter evaluation of tests for diagnosis of histoplasmosis. Clin Infect Dis. 2011;53(5):448–54.
Wheat J, Wheat H, Connolly P, et al. Cross-reactivity in Histoplasma capsulatum variety capsulatum antigen assays of urine samples from patients with endemic mycoses. Clin Infect Dis. 1997;24(6):1169–71.
Kuberski T, Myers R, Wheat LJ, et al. Diagnosis of coccidioidomycosis by antigen detection using cross-reaction with a Histoplasma antigen. Clin Infect Dis. 2007;44(5):e50–4.
Vergidis P, Walker RC, Kaul DR, et al. False-positive Aspergillus galactomannan assay in solid organ transplant recipients with histoplasmosis. Transpl Infect Dis. 2012;14(2):213–7.
Hage CA, Davis TE, Fuller D, et al. Diagnosis of histoplasmosis by antigen detection in BAL fluid. Chest. 2010;137(3):623–8.
Egan L, Connolly P, Wheat LJ, et al. Histoplasmosis as a cause for a positive Fungitell (1→3)-beta-D-glucan test. Med Mycol. 2008;46(1):93–5.
Wheat LJ. Approach to the diagnosis of the endemic mycoses. Clin Chest Med. 2009;30(2):379–89, viii.
Bialek R, Feucht A, Aepinus C, et al. Evaluation of two nested PCR assays for detection of Histoplasma capsulatum DNA in human tissue. J Clin Microbiol. 2002;40(5):1644–7.
Babady NE, Buckwalter SP, Hall L, et al. Detection of Blastomyces dermatitidis and Histoplasma capsulatum from culture isolates and clinical specimens by use of real-time PCR. J Clin Microbiol. 2011;49(9):3204–8.
Tang YW, Li H, Durkin MM, et al. Urine polymerase chain reaction is not as sensitive as urine antigen for the diagnosis of disseminated histoplasmosis. Diagn Microbiol Infect Dis. 2006;54(4):283–7.
Wheat LJ. Improvements in diagnosis of histoplasmosis. Expert Opin Biol Ther. 2006;6(11):1207–21.
Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45(7):807–25.
Johnson PC, Wheat LJ, Cloud GA, et al. Safety and efficacy of liposomal amphotericin B compared with conventional amphotericin B for induction therapy of histoplasmosis in patients with AIDS. Ann Intern Med. 2002;137(2):105–9.
Freifeld A, Proia L, Andes D, et al. Voriconazole use for endemic fungal infections. Antimicrob Agents Chemother. 2009;53(4):1648–51.
Restrepo A, Tobon A, Clark B, et al. Salvage treatment of histoplasmosis with posaconazole. J Infect. 2007;54(4):319–27.
Wheat LJ, Connolly P, Smedema M, et al. Activity of newer triazoles against Histoplasma capsulatum from patients with AIDS who failed fluconazole. J Antimicrob Chemother. 2006;57(6):1235–9.
Kohler S, Wheat LJ, Connolly P, et al. Comparison of the echinocandin caspofungin with amphotericin B for treatment of histoplasmosis following pulmonary challenge in a murine model. Antimicrob Agents Chemother. 2000;44(7):1850–4.
Hage CA, Connolly P, Horan D, et al. Investigation of the efficacy of micafungin in the treatment of histoplasmosis using two north American strains of Histoplasma capsulatum. Antimicrob Agents Chemother. 2011;55(9):4447–50.
Hage CA, Kirsch EJ, Stump TE, et al. Histoplasma antigen clearance during treatment of histoplasmosis in patients with AIDS determined by a quantitative antigen enzyme immunoassay. Clin Vaccine Immunol. 2011;18(4):661–6.
Goldman M, Zackin R, Fichtenbaum CJ, et al. Safety of discontinuation of maintenance therapy for disseminated histoplasmosis after immunologic response to antiretroviral therapy. Clin Infect Dis. 2004;38(10):1485–9.
Cano MV, Hajjeh RA. The epidemiology of histoplasmosis: a review. Semin Respir Infect. 2001;16(2):109–18.
Kang SH, Deziel PJ, Razonable RR. Pre-transplant serology, lung nodules, calcified mediastinal lymph nodes, and the risk of histoplasmosis after liver transplantation. 49th interscience conference on antimicrobial agents and chemotherapy. San Francisco; 2009.
Dodge RR, Lebowitz MD, Barbee R, et al. Estimates of C. immitis infection by skin test reactivity in an endemic community. Am J Public Health. 1985;75(8):863–5.
Sunenshine RH, Anderson S, Erhart L, et al. Public health surveillance for coccidioidomycosis in Arizona. Ann N Y Acad Sci. 2007;1111:96–102.
Cohen IM, Galgiani JN, Potter D, et al. Coccidioidomycosis in renal replacement therapy. Arch Intern Med. 1982;142(3):489–94.
Blair JE. Coccidioidomycosis in patients who have undergone transplantation. Ann N Y Acad Sci. 2007;1111:365–76.
Blair JE, Douglas DD. Coccidioidomycosis in liver transplant recipients relocating to an endemic area. Dig Dis Sci. 2004;49(11–12):1981–5.
Cha JM, Jung S, Bahng HS, et al. Multi-organ failure caused by reactivated coccidioidomycosis without dissemination in a patient with renal transplantation. Respirology. 2000;5(1):87–90.
Vartivarian SE, Coudron PE, Markowitz SM. Disseminated coccidioidomycosis. Unusual manifestations in a cardiac transplantation patient. Am J Med. 1987;83(5):949–52.
Vucicevic D, Carey EJ, Blair JE. Coccidioidomycosis in liver transplant recipients in an endemic area. Am J Transplant. 2011;11(1):111–9.
Miller MB, Hendren R, Gilligan PH. Posttransplantation disseminated coccidioidomycosis acquired from donor lungs. J Clin Microbiol. 2004;42(5):2347–9.
Tripathy U, Yung GL, Kriett JM, et al. Donor transfer of pulmonary coccidioidomycosis in lung transplantation. Ann Thorac Surg. 2002;73(1):306–8.
Wright PW, Pappagianis D, Wilson M, et al. Donor-related coccidioidomycosis in organ transplant recipients. Clin Infect Dis. 2003;37(9):1265–9.
Brugiere O, Forget E, Biondi G, et al. Coccidioidomycosis in a lung transplant recipient acquired from the donor graft in France. Transplantation. 2009;88(11):1319–20.
Wieden MA, Galgiani JN, Pappagianis D. Comparison of immunodiffusion techniques with standard complement fixation assay for quantitation of coccidioidal antibodies. J Clin Microbiol. 1983;18(3):529–34.
Zartarian M, Peterson EM, de la Maza LM. Detection of antibodies to Coccidioides immitis by enzyme immunoassay. Am J Clin Pathol. 1997;107(2):148–53.
Blair JE, Coakley B, Santelli AC, et al. Serologic testing for symptomatic coccidioidomycosis in immunocompetent and immunosuppressed hosts. Mycopathologia. 2006;162(5):317–24.
Durkin M, Connolly P, Kuberski T, et al. Diagnosis of coccidioidomycosis with use of the Coccidioides antigen enzyme immunoassay. Clin Infect Dis. 2008;47(8):e69–73.
Binnicker MJ, Buckwalter SP, Eisberner JJ, et al. Detection of Coccidioides species in clinical specimens by real-time PCR. J Clin Microbiol. 2007;45(1):173–8.
Vucicevic D, Blair JE, Binnicker MJ, et al. The utility of Coccidioides polymerase chain reaction testing in the clinical setting. Mycopathologia. 2010;170(5):345–51.
Galgiani JN, Ampel NM, Blair JE, et al. Coccidioidomycosis. Clin Infect Dis. 2005;41(9):1217–23.
Galgiani JN, Catanzaro A, Cloud GA, et al. Comparison of oral fluconazole and itraconazole for progressive, nonmeningeal coccidioidomycosis. A randomized, double-blind trial. Mycoses Study Group. Ann Intern Med. 2000;133(9):676–86.
Proia LA, Tenorio AR. Successful use of voriconazole for treatment of Coccidioides meningitis. Antimicrob Agents Chemother. 2004;48(6):2341.
Prabhu RM, Bonnell M, Currier BL, et al. Successful treatment of disseminated nonmeningeal coccidioidomycosis with voriconazole. Clin Infect Dis. 2004;39(7):e74–7.
Cortez KJ, Walsh TJ, Bennett JE. Successful treatment of coccidioidal meningitis with voriconazole. Clin Infect Dis. 2003;36(12):1619–22.
Anstead GM, Corcoran G, Lewis J, et al. Refractory coccidioidomycosis treated with posaconazole. Clin Infect Dis. 2005;40(12):1770–6.
Catanzaro A, Cloud GA, Stevens DA, et al. Safety, tolerance, and efficacy of posaconazole therapy in patients with nonmeningeal disseminated or chronic pulmonary coccidioidomycosis. Clin Infect Dis. 2007;45(5):562–8.
Stevens DA, Rendon A, Gaona-Flores V, et al. Posaconazole therapy for chronic refractory coccidioidomycosis. Chest. 2007;132(3):952–8.
Galgiani JN, Catanzaro A, Cloud GA, et al. Fluconazole therapy for coccidioidal meningitis. The NIAID-Mycoses Study Group. Ann Intern Med. 1993;119(1):28–35.
Tucker RM, Denning DW, Dupont B, et al. Itraconazole therapy for chronic coccidioidal meningitis. Ann Intern Med. 1990;112(2):108–12.
Dewsnup DH, Galgiani JN, Graybill JR, et al. Is it ever safe to stop azole therapy for Coccidioides immitis meningitis? Ann Intern Med. 1996;124(3):305–10.
Antony SJ, Dummer SJ, McNeil KK, et al. Coccidioidomycosis in Renal Transplant Recipients. Infect Dis Clin Pract. 2005;13(5):250–4.
Gnann JW Jr, Bressler GS, Bodet CA 3rd, et al. Human blastomycosis after a dog bite. Ann Intern Med. 1983;98(1):48–9.
Gauthier GM, Safdar N, Klein BS, et al. Blastomycosis in solid organ transplant recipients. Transpl Infect Dis. 2007;9(4):310–7.
Grim SA, Proia L, Miller R, et al. A multicenter study of histoplasmosis and blastomycosis after solid organ transplantation. Transpl Infect Dis. 2012;14(1):17–23.
Bariola JR, Perry P, Pappas PG, et al. Blastomycosis of the central nervous system: a multicenter review of diagnosis and treatment in the modern era. Clin Infect Dis. 2010;50(6):797–804.
Martynowicz MA, Prakash UB. Pulmonary blastomycosis: an appraisal of diagnostic techniques. Chest. 2002;121(3):768–73.
Klein BS, Kuritsky JN, Chappell WA, et al. Comparison of the enzyme immunoassay, immunodiffusion, and complement fixation tests in detecting antibody in human serum to the A antigen of Blastomyces dermatitidis. Am Rev Respir Dis. 1986;133(1):144–8.
Bradsher RW, Pappas PG. Detection of specific antibodies in human blastomycosis by enzyme immunoassay. South Med J. 1995;88(12):1256–9.
Bariola JR, Hage CA, Durkin M, et al. Detection of Blastomyces dermatitidis antigen in patients with newly diagnosed blastomycosis. Diagn Microbiol Infect Dis. 2011;69(2):187–91.
Durkin M, Witt J, Lemonte A, et al. Antigen assay with the potential to aid in diagnosis of blastomycosis. J Clin Microbiol. 2004;42(10):4873–5.
Connolly P, Hage CA, Bariola JR, et al. Blastomyces dermatitidis antigen detection by quantitative enzyme immunoassay. Clin Vaccine Immunol. 2012;19(1):53–6.
Bialek R, Cirera AC, Herrmann T, et al. Nested PCR assays for detection of Blastomyces dermatitidis DNA in paraffin-embedded canine tissue. J Clin Microbiol. 2003;41(1):205–8.
Chapman SW, Dismukes WE, Proia LA, et al. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(12):1801–12.
Dismukes WE, Bradsher RW Jr, Cloud GC, et al. Itraconazole therapy for blastomycosis and histoplasmosis. NIAID Mycoses Study Group. Am J Med. 1992;93(5):489–97.
Pappas PG, Bradsher RW, Kauffman CA, et al. Treatment of blastomycosis with higher doses of fluconazole. The National Institute of Allergy and Infectious Diseases Mycoses Study Group. Clin Infect Dis. 1997;25(2):200–5.
Pappas PG, Bradsher RW, Chapman SW, et al. Treatment of blastomycosis with fluconazole: a pilot study. The National Institute of Allergy and Infectious Diseases Mycoses Study Group. Clin Infect Dis. 1995;20(2):267–71.
Bakleh M, Aksamit AJ, Tleyjeh IM, et al. Successful treatment of cerebral blastomycosis with voriconazole. Clin Infect Dis. 2005;40(9):e69–71.
Borgia SM, Fuller JD, Sarabia A, et al. Cerebral blastomycosis: a case series incorporating voriconazole in the treatment regimen. Med Mycol. 2006;44(7):659–64.
Proia LA, Harnisch DO. Successful use of posaconazole for treatment of blastomycosis. Antimicrob Agents Chemother. 2012;56(7):4029.
Blotta MH, Mamoni RL, Oliveira SJ, et al. Endemic regions of paracoccidioidomycosis in Brazil: a clinical and epidemiologic study of 584 cases in the southeast region. Am J Trop Med Hyg. 1999;61(3):390–4.
Zavascki AP, Bienardt JC, Severo LC. Paracoccidioidomycosis in organ transplant recipient: case report. Rev Inst Med Trop Sao Paulo. 2004;46(5):279–81.
Shikanai-Yasuda MA, Duarte MI, Nunes DF, et al. Paracoccidioidomycosis in a renal transplant recipient. J Med Vet Mycol. 1995;33(6):411–4.
Sugar AM, Restrepo A, Stevens DA. Paracoccidioidomycosis in the immunosuppressed host: report of a case and review of the literature. Am Rev Respir Dis. 1984;129(2):340–2.
de Camargo ZP. Serology of paracoccidioidomycosis. Mycopathologia. 2008;165(4–5):289–302.
da Silva SH, Grosso Dde M, Lopes JD, et al. Detection of Paracoccidioides brasiliensis gp70 circulating antigen and follow-up of patients undergoing antimycotic therapy. J Clin Microbiol. 2004;42(10):4480–6.
Chan YH, Wong KM, Lee KC, et al. Pneumonia and mesenteric lymphadenopathy caused by disseminated Penicillium marneffei infection in a cadaveric renal transplant recipient. Transpl Infect Dis. 2004;6(1):28–32.
Lin JN, Lin HH, Lai CH, et al. Renal transplant recipient infected with Penicillium marneffei. Lancet Infect Dis. 2010;10(2):138.
Wang JL, Hung CC, Chang SC, et al. Disseminated Penicillium marneffei infection in a renal-transplant recipient successfully treated with liposomal amphotericin B. Transplantation. 2003;76(7):1136–7.
Hart J, Dyer JR, Clark BM, et al. Travel-related disseminated Penicillium marneffei infection in a renal transplant patient. Transpl Infect Dis. 2012;14(4):434–9. Epub 2011 Dec 20.
Gullberg RM, Quintanilla A, Levin ML, et al. Sporotrichosis: recurrent cutaneous, articular, and central nervous system infection in a renal transplant recipient. Rev Infect Dis. 1987;9(2):369–75.
Agarwal SK, Tiwari SC, Dash SC, et al. Urinary sporotrichosis in a renal allograft recipient. Nephron. 1994;66(4):485.
Kauffman CA, Bustamante B, Chapman SW, et al. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45(10):1255–65.
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Vergidis, P., Hage, C.A., Wheat, L.J. (2019). Histoplasmosis, Coccidioidomycosis, and Diseases Due to Other Endemic Fungi in Transplant Recipients. In: Safdar, A. (eds) Principles and Practice of Transplant Infectious Diseases. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-9034-4_36
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