What is the incidence of coccidioidomycosis in transplant recipients?

Updated: Aug 27, 2019
  • Author: Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The immunosuppressive regimen that transplant recipients require places them at increased risk for coccidioidomycosis. A review of coccidioidomycosis in solid organ transplant recipients in an endemic area showed an incidence of 5.7%.

Patients with a history of the disease may experience reactivation or contract primary infection from the donated organ or the environment. [89] Clinical manifestations are similar to those in normal hosts, but dissemination is more frequent (25%) and more rapid. Previously resolved infections reactivate at a rate of approximately 10% per year. Prior coccidioidomycosis does not contraindicate transplantation.

No clear consensus on prophylaxis has been reached. Many programs advocate lifelong prophylaxis, in which case the risks of emergence of resistance and side effects of azole therapy should be considered. The Mayo Clinic Hospital in Arizona advocates a targeted approach to prophylaxis and treatment. [89, 90] Fluconazole is the most commonly used azole.


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