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Endemic Mycoses After Hematopoietic Stem Cell or Solid Organ Transplantation

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Transplant Infections

Abstract

Histoplasmosis, blastomycosis, and coccidioidomycosis are uncommon, but often life-threatening infections in transplant recipients. Infection with an endemic mycosis occurs as a result of new infection related to an environmental exposure; from the reactivation of a previously acquired infection; and, least often, from the donor organ. Infection can occur at any time after the transplantation for as long as cell-mediated immune defects are present. Severe pulmonary infection and widespread disseminated infection are the most common manifestations of infection with an endemic mycosis after transplantation. Early presumptive diagnosis is most speedily accomplished by histopathological examination of tissue obtained by biopsy, seeking the distinctive appearance of these organisms. Antigen detection is increasingly used for the rapid diagnosis of histoplasmosis and blastomycosis. For the initial treatment of most transplant recipients, lipid formulation amphotericin B is preferred. After the initial response, an oral azole agent can be given to complete therapy. Long-term suppressive azole therapy may be indicated for those patients who remain markedly immunosuppressed.

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Authors and Affiliations

  1. Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI, USA

    Carol A. Kauffman M.D. & Marisa H. Miceli M.D.

  2. Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA

    Carol A. Kauffman M.D.

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  1. Carol A. Kauffman M.D.
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  2. Marisa H. Miceli M.D.
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Correspondence to Carol A. Kauffman M.D. .

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  1. Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Per Ljungman

  2. Tufts University School of Medicine Tufts Medical Center, Boston, MA, USA

    David Snydman

  3. University of Washington Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Michael Boeckh

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Kauffman, C.A., Miceli, M.H. (2016). Endemic Mycoses After Hematopoietic Stem Cell or Solid Organ Transplantation. In: Ljungman, P., Snydman, D., Boeckh, M. (eds) Transplant Infections. Springer, Cham. https://doi.org/10.1007/978-3-319-28797-3_41

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