SpringerLink
Log in

Coccidioidomycosis and Solid Organ Transplantation

  • Fungal Infections in Transplantation (S Shoham, Section Editor)
  • Published:
Current Fungal Infection Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review discusses the epidemiology, microbiology and pathogenesis, prevention, diagnosis, and treatment of coccidioidomycosis in solid organ transplant recipients.

Recent Findings

Coccidioidomycosis is associated with a high mortality in solid organ transplant recipients than in immunocompetent individuals. Within the endemic area, strategies to reduce the incidence and mortality among solid organ transplant recipients include pretransplantation screening and treatment of coccidioidomycosis among donors and recipients, use of universal azole prophylaxis after transplantation, and more aggressive treatment of asymptomatic or primary pulmonary coccidioidomycosis after transplantation.

Summary

Coccidioidomycosis is an endemic infection in the southwestern United States that is associated with high rates of dissemination and mortality among solid organ transplant recipients. Patients can acquire coccidioidomycosis after transplantation via primary infection after transplantation, reactivation of prior infection, or infection acquired from the transplanted organ. Although some solid organ transplant recipients with coccidioidomycosis may be asymptomatic, in general, solid organ transplant recipients have more severe disease and a higher mortality rate than immunocompetent persons. Various strategies have been used to reduce the incidence and mortality among solid organ transplant recipients. Fluconazole is commonly used as the first-line treatment of asymptomatic or primary pulmonary coccidioidomycosis, but other azole therapy may be useful in patients intolerant to fluconazole. In patients with rapidly progressive coccidioidomycosis, amphotericin B is often used first, followed by fluconazole.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

EIA:

Enzyme-linked immunosorbent assay

CF:

Complement fixation

ID:

Immunodiffusion

IgM:

Immunoglobulin M

IgG:

Immunoglobulin G

ATS:

American Thoracic Society

IDSA:

The Infectious Disease Society of America

AST:

American Society of Transplantation

CDC:

Centers of Disease Control and Prevention

HIV:

Human immunodeficiency virus

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Cohen IM, et al. Coccidioidomycosis in renal replacement therapy. Arch Intern Med. 1982;142(3):489–94.

    Article  CAS  PubMed  Google Scholar 

  2. Holt CD, et al. Coccidioidomycosis in liver transplant patients. Clin Infect Dis. 1997;24(2):216–21.

    Article  CAS  PubMed  Google Scholar 

  3. Valley Fever Maps. Available from: https://www.cdc.gov/fungal/diseases/coccidioidomycosis/maps.html.

  4. 2019 Annual Tables of Infectious Disease Data. Centers for Disease Control and Prevention. National Notifiable Diseases Surveillance System, CDC Division of Health Informatics and Surveillance: Atlanta.

  5. Blair JE, Logan JL. Coccidioidomycosis in solid organ transplantation. Clin Infect Dis. 2001;33(9):1536–44.

    Article  CAS  PubMed  Google Scholar 

  6. Blair JE. Coccidioidomycosis in liver transplantation. Liver Transpl. 2006;12(1):31–9.

    Article  PubMed  Google Scholar 

  7. Blair JE. Coccidioidomycosis in patients who have undergone transplantation. Ann N Y Acad Sci. 2007;1111:365–76.

    Article  PubMed  Google Scholar 

  8. Blair JE, Douglas DD, Mulligan DC. Early results of targeted prophylaxis for coccidioidomycosis in patients undergoing orthotopic liver transplantation within an endemic area. Transpl Infect Dis. 2003;5(1):3–8.

    Article  CAS  PubMed  Google Scholar 

  9. Braddy CM, Heilman RL, Blair JE. Coccidioidomycosis after renal transplantation in an endemic area. Am J Transplant. 2006;6(2):340–5.

    Article  CAS  PubMed  Google Scholar 

  10. Bergstrom L, et al. Increased risk of coccidioidomycosis in patients treated with tumor necrosis factor alpha antagonists. Arthritis Rheum. 2004;50(6):1959–66.

    Article  CAS  PubMed  Google Scholar 

  11. Santelli AC, Blair JE, Roust LR. Coccidioidomycosis in patients with diabetes mellitus. Am J Med. 2006;119(11):964–9.

    Article  PubMed  Google Scholar 

  12. Wheeler C, Lucas KD, Mohle-Boetani JC. Rates and risk factors for Coccidioidomycosis among prison inmates, California, USA, 2011. Emerg Infect Dis. 2015;21(1):70–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ampel NM, Dols CL, Galgiani JN. Coccidioidomycosis during human immunodeficiency virus infection: results of a prospective study in a coccidioidal endemic area. Am J Med. 1993;94(3):235–40.

    Article  CAS  PubMed  Google Scholar 

  14. Fish DG, et al. Coccidioidomycosis during human immunodeficiency virus infection. A review of 77 patients. Medicine (Baltimore). 1990;69(6):384–91.

    Article  CAS  Google Scholar 

  15. Woods CW, et al. Coccidioidomycosis in human immunodeficiency virus-infected persons in Arizona, 1994–1997: incidence, risk factors, and prevention. J Infect Dis. 2000;181(4):1428–34.

    Article  CAS  PubMed  Google Scholar 

  16. Leake JA, et al. Risk factors for acute symptomatic coccidioidomycosis among elderly persons in Arizona, 1996–1997. J Infect Dis. 2000;181(4):1435–40.

    Article  CAS  PubMed  Google Scholar 

  17. Rosenstein NE, et al. Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995–1996. Clin Infect Dis. 2001;32(5):708–14.

    Article  CAS  PubMed  Google Scholar 

  18. Prevention, C.f.D.C.a., Biology of Coccidioidomycosis. https://www.cdc.gov/fungal/diseases/coccidioidomycosis/pdf/coccidiomycosis-lifecycle508c.pdf.

  19. Stevens DA. Coccidioidomycosis. N Engl J Med. 1995;332(16):1077–82.

    Article  CAS  PubMed  Google Scholar 

  20. Hector RF, Laniado-Laborin R. Coccidioidomycosis–a fungal disease of the Americas. PLoS Med. 2005;2(1):e2.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Smith CE, Beard RR, et al. Varieties of coccidioidal infection in relation to the epidemiology and control of the diseases. Am J Public Health Nations Health. 1946;36(12):1394–402.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Nokes BT, Blair JE. Coccidioidomycosis in transplantation. In: Morris MI, Kotton CN, Wolfe C, editors. emerging transplant infections: clinical challenges and implications. Cham: Springer International Publishing; 2020. p. 1–18.

    Google Scholar 

  23. Hung CY, et al. A review of innate and adaptive immunity to coccidioidomycosis. Med Mycol. 2019;57(Supplement_1):S85–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Diep AL and Hoyer KK. Host Response to coccidioides infection: fungal immunity. Front Cell Infect Microbiol. 2020;10(692).

  25. Castro-Lopez N and Hung CY. Immune response to coccidioidomycosis and the development of a vaccine. Microorganisms. 2017;5(1).

  26. Ampel NM. The complex immunology of human coccidioidomycosis. Ann N Y Acad Sci. 2007;1111:245–58.

    Article  CAS  PubMed  Google Scholar 

  27. van Besouw NM, et al. Tapering immunosuppressive therapy significantly improves in vivo cutaneous delayed type hypersensitivity responses. Transpl Immunol. 2008;19(3–4):229–34.

    Article  PubMed  Google Scholar 

  28. Galgiani JN, et al. 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis. Clin Infect Dis. 2016;63(6):e112–46.

    Article  PubMed  Google Scholar 

  29. Kotton CN, et al. Coccidioidal meningitis after liver transplantation in a nonendemic region: a case report. Transplantation. 2006;81(1):132–4.

    Article  PubMed  Google Scholar 

  30. Carvalho C, et al. Cerebral coccidioidomycosis after renal transplantation in a non-endemic area. Transpl Infect Dis. 2010;12(2):151–4.

    Article  CAS  PubMed  Google Scholar 

  31. Yoshino MT, Hillman BJ, Galgiani JN. Coccidioidomycosis in renal dialysis and transplant patients: radiologic findings in 30 patients. AJR Am J Roentgenol. 1987;149(5):989–92.

    Article  CAS  PubMed  Google Scholar 

  32. Chandler JW, Kalina RE, Milam DF. Coccidioidal choroiditis following renal transplantation. Am J Ophthalmol. 1972;74(6):1080–5.

    Article  CAS  PubMed  Google Scholar 

  33. Diaz MA et al. Coccidioides in lung transplant: case report. BMJ Case Rep. 2020;13(4).

  34. Vartivarian SE, Coudron PE, Markowitz SM. Disseminated coccidioidomycosis. Unusual manifestations in a cardiac transplantation patient. Am J Med. 1987;83(5):949–52.

    Article  CAS  PubMed  Google Scholar 

  35. Theodoropoulos N, Angarone M. Photo quiz. Lip lesion in a solid organ transplant recipient. Clin Infect Dis. 2012;54(9):1332, 1373–13321374.

    Article  Google Scholar 

  36. McAninch EA, et al. Coccidiomycosis thyroiditis in an immunocompromised host post-transplant: case report and literature review. J Clin Endocrinol Metab. 2014;99(5):1537–42.

    Article  CAS  PubMed  Google Scholar 

  37. Blair JE, et al. Serologic testing for symptomatic coccidioidomycosis in immunocompetent and immunosuppressed hosts. Mycopathologia. 2006;162(5):317–24.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Mendoza N, Blair JE. The utility of diagnostic testing for active coccidioidomycosis in solid organ transplant recipients. Am J Transplant. 2013;13(4):1034–9.

    Article  CAS  PubMed  Google Scholar 

  39. Hage CA, et al. Microbiological laboratory testing in the diagnosis of fungal infections in pulmonary and critical care practice. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2019;200(5):535–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Kuberski T, et al. Diagnosis of coccidioidomycosis by antigen detection using cross-reaction with a Histoplasma antigen. Clin Infect Dis. 2007;44(5):e50–4.

    Article  PubMed  Google Scholar 

  41. Durkin M, et al. Diagnosis of Coccidioidomycosis with use of the coccidioides antigen enzyme immunoassay. Clin Infect Dis. 2008;47(8):e69–73.

    Article  PubMed  Google Scholar 

  42. Thompson GR 3rd, et al. Serum (1->3)-β-D-glucan measurement in coccidioidomycosis. J Clin Microbiol. 2012;50(9):3060–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Jude CM, et al. Pulmonary coccidioidomycosis: pictorial review of chest radiographic and CT findings. Radiographics. 2014;34(4):912–25.

    Article  PubMed  Google Scholar 

  44. Phonphok K, et al. Screening Coccidioides serology in kidney transplant recipients: a 10-year cross-sectional analysis. Transpl Infect Dis. 2018;20(5):e12932.

    Article  PubMed  Google Scholar 

  45. Kahn A, Carey EJ, Blair JE. Universal fungal prophylaxis and risk of coccidioidomycosis in liver transplant recipients living in an endemic area. Liver Transpl. 2015;21(3):353–61.

    Article  PubMed  Google Scholar 

  46. • Asbury K, et al. De novo coccidioidomycosis among solid organ transplant recipients 1 or more years after transplant. Am J Transplant. 2019;19(9):2517–24. Incidence and presentation of de novo Coccidioidomycosis 1 year after transplantation.

    Article  PubMed  Google Scholar 

  47. Blair JE. Coccidioidal pneumonia, arthritis, and soft-tissue infection after kidney transplantation. Transpl Infect Dis. 2004;6(2):74–6.

    Article  CAS  PubMed  Google Scholar 

  48. • Miller R, Assi M. Endemic fungal infections in solid organ transplant recipients-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13553. American Society of Transplantation recommendations on diagnosis, prevention, and treatment of Coccidioidomycosis in solid organ transplant recipients.

    Article  PubMed  Google Scholar 

  49. Kusne S, et al. Coccidioidomycosis transmission through organ transplantation: a report of the OPTN Ad Hoc Disease Transmission Advisory Committee. Am J Transplant. 2016;16(12):3562–7.

    Article  CAS  PubMed  Google Scholar 

  50. Nelson JK, et al. Donor-derived Coccidioides immitis endocarditis and disseminated infection in the setting of solid organ transplantation. Open Forum Infect Dis. 2016;3(3):ofw086.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Blair JE, Mulligan DC. Coccidioidomycosis in healthy persons evaluated for liver or kidney donation. Transpl Infect Dis. 2007;9(1):78–82.

    Article  CAS  PubMed  Google Scholar 

  52. Dierberg KL, et al. Donor-derived organ transplant transmission of coccidioidomycosis. Transpl Infect Dis. 2012;14(3):300–4.

    Article  CAS  PubMed  Google Scholar 

  53. Pappagianis D, Zimmer BL. Serology of coccidioidomycosis. Clin Microbiol Rev. 1990;3(3):247–68.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Singh N, et al. Donor-derived fungal infections in organ transplant recipients: guidelines of the American Society of Transplantation, infectious diseases community of practice. Am J Transplant. 2012;12(9):2414–28.

    Article  CAS  PubMed  Google Scholar 

  55. Limper AH, et al. An official American Thoracic Society statement: treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med. 2011;183(1):96–128.

    Article  CAS  PubMed  Google Scholar 

  56. Kim MM, et al. Treatment of refractory coccidioidomycosis with voriconazole or posaconazole. Clin Infect Dis. 2011;53(11):1060–6.

    Article  CAS  PubMed  Google Scholar 

  57. Puing AG, et al. Simultaneous coccidioidomycosis and phaeohyphomycosis in a kidney transplant recipient: a case report and literature review. Transpl Infect Dis. 2020;22(6):e13365.

    Article  PubMed  Google Scholar 

  58. Galgiani JN. Coccidioidomycosis. Curr Clin Top Infect Dis. 1997;17:188–204.

    CAS  PubMed  Google Scholar 

  59. Kaplan JE, Zoschke D, Kisch AL. Withdrawal of immunosuppresive agents in the treatment of disseminated coccidioidomycosis. Am J Med. 1980;68(4):624–8.

    Article  CAS  PubMed  Google Scholar 

  60. Cervelli MJ. Fluconazole-sirolimus drug interaction. Transplantation. 2002;74(10):1477–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Mayo Clinic in Arizona, Phoenix, AZ, USA

    Muskan Agarwal

  2. Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California San Diego, San Diego, CA, USA

    Brandon Nokes

  3. Division of Infectious Diseases, Mayo Clinic in Arizona, Phoenix, AZ, USA

    Janis E. Blair

Authors
  1. Muskan Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brandon Nokes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Janis E. Blair
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Janis E. Blair.

Ethics declarations

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Fungal Infections in Transplantation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agarwal, M., Nokes, B. & Blair, J.E. Coccidioidomycosis and Solid Organ Transplantation. Curr Fungal Infect Rep 15, 143–150 (2021). https://doi.org/10.1007/s12281-021-00425-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12281-021-00425-7

Keywords

Search

Navigation