What is the treatment of coccidioidomycosis during the pretransplant period?

Updated: Aug 27, 2019
  • Author: Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH; Chief Editor: Michael Stuart Bronze, MD  more...
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Special attention should be given to patients with end-stage liver disease or alcoholic liver disease and patients on prednisone therapy, because their risk is higher and diagnosis is difficult, as it mimics the underlying disease. All patients should provide a detailed history (including residence in and travel to endemic areas) and undergo serologic testing, immunodiffusion, complement fixation, and chest radiography. These tests should be repeated the day of the transplant and should be repeated annually. All patients should be cleared by an infectious disease specialist.

If the diagnosis of coccidioidomycosis is made during the pre-evaluation testing, treatment is recommended for a year or more, and transplant surgery should be postponed until coccidioidomycosis is cleared. Follow with lifelong antifungal therapy thereafter.

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