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A multicenter study of histoplasmosis and blastomycosis after solid organ transplantation.
Transpl Infect Dis. 2012 Feb; 14(1):17-23.TI

Abstract

AIM

A review of the clinical presentation, diagnosis, treatment and outcomes of 30 solid organ transplant recipients (SOTRs) with histoplasmosis or blastomycosis from 3 Midwestern academic medical centers.

BACKGROUND

The endemic fungal pathogens, Histoplasma capsulatum and Blastomyces dermatitidis, may cause severe infection in SOTRs. In this report, we describe the clinical presentation, diagnosis, treatment, and outcomes of these endemic fungal infections (EFIs) among SOTRs at 3 academic transplant centers.

METHODS

A retrospective review was conducted of SOTRs with histoplasmosis or blastomycosis from 3 Midwestern medical centers in the United States. Data collected included demographics, immunosuppression, clinical presentation, method of diagnosis, antifungal treatment, response to therapy, and patient and graft survival.

RESULTS

Between 1996 and 2008, 30 transplant recipients with histoplasmosis or blastomycosis were identified, giving a cumulative incidence of infection of 0.50% (30/5989); 73% of the study patients were renal transplant recipients, and the median time to disease onset after transplantation was 10.5 months. The lungs were the most common site of infection (83%), and 60% had disseminated disease. Urine antigen testing was positive in all patients in whom it was performed (23/23). Initial antifungal therapy consisted of amphotericin B in 70%, and 87% received azoles, typically itraconazole (83%). Two patients developed relapsed infection and 7 patients had graft failure after EFI. Overall mortality was 30%, with an attributable mortality of 13%.

CONCLUSIONS

As in several previous single-center studies, the incidence of post-transplant histoplasmosis and blastomycosis was <1%, but often resulted in disseminated infection. In this cohort, EFI was associated with a high rate of allograft loss and overall mortality.

Authors+Show Affiliations

Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois 60612, USA. sgrim@uic.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

21749587

Citation

Grim, S A., et al. "A Multicenter Study of Histoplasmosis and Blastomycosis After Solid Organ Transplantation." Transplant Infectious Disease : an Official Journal of the Transplantation Society, vol. 14, no. 1, 2012, pp. 17-23.
Grim SA, Proia L, Miller R, et al. A multicenter study of histoplasmosis and blastomycosis after solid organ transplantation. Transpl Infect Dis. 2012;14(1):17-23.
Grim, S. A., Proia, L., Miller, R., Alhyraba, M., Costas-Chavarri, A., Oberholzer, J., & Clark, N. M. (2012). A multicenter study of histoplasmosis and blastomycosis after solid organ transplantation. Transplant Infectious Disease : an Official Journal of the Transplantation Society, 14(1), 17-23. https://doi.org/10.1111/j.1399-3062.2011.00658.x
Grim SA, et al. A Multicenter Study of Histoplasmosis and Blastomycosis After Solid Organ Transplantation. Transpl Infect Dis. 2012;14(1):17-23. PubMed PMID: 21749587.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A multicenter study of histoplasmosis and blastomycosis after solid organ transplantation. AU - Grim,S A, AU - Proia,L, AU - Miller,R, AU - Alhyraba,M, AU - Costas-Chavarri,A, AU - Oberholzer,J, AU - Clark,N M, Y1 - 2011/07/12/ PY - 2011/7/14/entrez PY - 2011/7/14/pubmed PY - 2012/6/12/medline SP - 17 EP - 23 JF - Transplant infectious disease : an official journal of the Transplantation Society JO - Transpl Infect Dis VL - 14 IS - 1 N2 - AIM: A review of the clinical presentation, diagnosis, treatment and outcomes of 30 solid organ transplant recipients (SOTRs) with histoplasmosis or blastomycosis from 3 Midwestern academic medical centers. BACKGROUND: The endemic fungal pathogens, Histoplasma capsulatum and Blastomyces dermatitidis, may cause severe infection in SOTRs. In this report, we describe the clinical presentation, diagnosis, treatment, and outcomes of these endemic fungal infections (EFIs) among SOTRs at 3 academic transplant centers. METHODS: A retrospective review was conducted of SOTRs with histoplasmosis or blastomycosis from 3 Midwestern medical centers in the United States. Data collected included demographics, immunosuppression, clinical presentation, method of diagnosis, antifungal treatment, response to therapy, and patient and graft survival. RESULTS: Between 1996 and 2008, 30 transplant recipients with histoplasmosis or blastomycosis were identified, giving a cumulative incidence of infection of 0.50% (30/5989); 73% of the study patients were renal transplant recipients, and the median time to disease onset after transplantation was 10.5 months. The lungs were the most common site of infection (83%), and 60% had disseminated disease. Urine antigen testing was positive in all patients in whom it was performed (23/23). Initial antifungal therapy consisted of amphotericin B in 70%, and 87% received azoles, typically itraconazole (83%). Two patients developed relapsed infection and 7 patients had graft failure after EFI. Overall mortality was 30%, with an attributable mortality of 13%. CONCLUSIONS: As in several previous single-center studies, the incidence of post-transplant histoplasmosis and blastomycosis was <1%, but often resulted in disseminated infection. In this cohort, EFI was associated with a high rate of allograft loss and overall mortality. SN - 1399-3062 UR - https://www.unboundmedicine.com/medline/citation/21749587/A_multicenter_study_of_histoplasmosis_and_blastomycosis_after_solid_organ_transplantation_ L2 - https://doi.org/10.1111/j.1399-3062.2011.00658.x DB - PRIME DP - Unbound Medicine ER -