Digestive Diseases and Sciences

, Volume 49, Issue 11–12, pp 1981–1985 | Cite as

Coccidioidomycosis in Liver Transplant Recipients Relocating to an Endemic Area

  • Janis E. Blair
  • David D. Douglas


Coccidioidomycosis is an endemic fungal infection of the desert southwestern United States. This infection occurs at a rate of 1% to 8% in solid organ transplant recipients residing in the endemic area, and it has a high rate of disseminated infection and mortality. The risk of infection among transplant recipients from nonendemic areas visiting or moving to an endemic region is not known. We reviewed the clinical course of 41 liver transplant recipients who originally resided in and underwent liver transplantation in an area of low coccidioidal endemicity and who later relocated their follow-up care to our program, which is located in an endemic area. No patients received antifungal prophylaxis to prevent primary coccidioidomycosis. Among 37 patients with at least 1 year of follow-up care, the incidence of new coccidioidal infection was 2.7%. Coccidioidomycosis was identified in one patient and was manifested by fatigue, anemia, and pulmonary nodules. This patient survived with oral antifungal therapy. Coccidioidomycosis was not a frequent event in liver transplant recipients from areas of low endemicity who relocated to our highly endemic area.

antifungal prophylaxis coccidioidal infections immunosuppression liver transplantation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Pappagianis D: Epidemiology of coccidioidomycosis. In Cocci- dioidomycosis: A Text. Stevens DA (ed). New York, Plenum Medical Book, 1980, pp 63–85Google Scholar
  2. 2.
    Galgiani JN: Coccidioidomycosis. West J Med 159:153–171, 1993PubMedPubMedCentralGoogle Scholar
  3. 3.
    Cantanzaro A, Drutz DJ: Primary coccidioidomycosis. In Cocci- dioidomycosis: A Text. Stevens DA (ed). New York, Plenum Medical Book, 1980, pp 139–145Google Scholar
  4. 4.
    Cohen IM, Galgiani JN, Potter D, Ogden DA: Coccidioidomycosis in renal replacement therapy. Arch Intern Med 142:489–494, 1982CrossRefPubMedGoogle Scholar
  5. 5.
    Hall KA, Sethi GK, Rosado LJ, Martinez JD, Huston CL, Copeland JG: Coccidioidomycosis and heart transplantation. J Heart Lung Transplant 12:525–526, 1993PubMedGoogle Scholar
  6. 6.
    Calhoun DL, Galgiani JN, Zukoski C, Copeland JG: Cocci- dioidomycosis in recent renal or cardiac transplant recipients. In Coccidioidomycosis: Proceedings of the 4th International Conference on Coccidioidomycosis, San Diego, CA, March 1984. Einstein HE, Cantanzaro A (eds). Washington, DC, National Foundation for Infectious Diseases, 1985, pp 312–318Google Scholar
  7. 7.
    Serota AI: The efficacy of fluconazole in prevention of cocci- dioidomycosis following renal transplantation. In Coccidioidomycosis: Proceedings of the 5th International Conference on Cocci- dioidomycosis, Stanford University, 24–27 August 1994: Centennial conference. Einstein HE, Cantanzaro A (eds). Bethesda, MD, National Foundation for Infectious Diseases Press, 1996, pp 248–254Google Scholar
  8. 8.
    Vermani V, Blair JE, Logan JL: Fluconazole is effective in decreasing the incidence of coccidioidomycosis in kidney transplants in an endemic area. Am J Transplant Suppl 3:506, 2003 (abstr)CrossRefGoogle Scholar
  9. 9.
    Blair JE, Logan JL: Coccidioidomycosis in solid organ transplantation. Clin Infect Dis 33:1536–1544, 2001CrossRefPubMedGoogle Scholar
  10. 10.
    Cha JM, Jung S, Bahng HS, et al.: Multiorgan failure caused by reactivated coccidioidomycosis without dissemination in a patient with renal transplantation. Respirology 5:87–90, 2000CrossRefPubMedGoogle Scholar
  11. 11.
    Magill SB, Schmahl TM, Sommer J, Doos WG, Pellegrini JG, Shaker JL: Coccidioidomycosis-induced thyroiditis and calcitriol-mediated hypercalcemia in a heart transplantation patient. Endocrinologist 8:299–302, 1998CrossRefGoogle Scholar
  12. 12.
    Vartivarian SE, Coudron PE, Markowitz SM: Disseminated cocci- dioidomycosis: Unusual manifestations in a cardiac transplantation patient. Am J Med 83:949–952, 1987CrossRefPubMedGoogle Scholar
  13. 13.
    Palmer DF, Kaufman L, Kaplan W, Cavallaro JJ: Serodiagnosis of Mycotic Diseases. Springfield, IL. Charles C. Thomas, 1977Google Scholar
  14. 14.
    Pappagianis D, Zimmer BL: Serology of coccidioidomycosis. Clin Microbiol Rev 3:247–268, 1990CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hall KA, Copeland JG, Zukoski CF, Sethi GK, Galgiani JN: Markers of coccidioidomycosis before cardiac or renal transplantation and the risk of recurrent infection. Transplantation 55:1422–1424, 1993CrossRefPubMedGoogle Scholar
  16. 16.
    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 5:3–8, 2003CrossRefPubMedGoogle Scholar
  17. 17.
    Canafax DM, Graves NM, Hilligoss DM, Carleton BC, Gardner MJ, Matas AJ: Interaction between cyclosporine and fluconazole in renal allograft recipients. Transplantation 51:1014–1018, 1991CrossRefPubMedGoogle Scholar
  18. 18.
    Manez R, Martin M, Raman D, et al.: Fluconazole therapy in transplant recipients receiving FK506. Transplantation 57:1521–1523, 1994CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2004

Authors and Affiliations

  • Janis E. Blair
    • 1
  • David D. Douglas
    • 2
  1. 1.Division of Infectious DiseasesMayo ClinicScottsdaleUSA
  2. 2.Division of Transplantation MedicineMayo ClinicScottsdaleUSA

Personalised recommendations