Coccidioidomycosis and Solid Organ Transplantation

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. 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.