Disseminated histoplasmosis in pediatric kidney transplant recipients—A report of six cases and review of the literature

Abstract

KTx patients in endemic areas are at risk for disseminated histoplasmosis. Further study is needed to determine which factors portend the need for fungal prophylaxis in this subset of patients.

Case report: Disseminated histoplasmosis in a renal transplant recipient from a non-endemic region

“…We thus present a case of disseminated histoplasmosis in a kidney transplant patient. While there have been previous reports of this in the literature, our case is unique in our patient's underlying genetic condition, travel history, and diagnosis with no known clear exposure to Histoplasma endemic areas (2,15). With the use of novel diagnostic techniques including Karius, serum metagenomics, and nextgeneration sequencing, we were eventually able to identify histoplasmosis, a feat that would have been difficult with cultures alone (16).…”

Histoplasmosis in Children; HIV/AIDS Not a Major Driver

“…While viral infections are far commoner in solid organ transplant recipients, fungal infections are usually more serious [ 50 ]. Studies have reported on occurrences of disseminated histoplasmosis in pediatric kidney transplant patients which are by far the commonest solid organ transplants done in the pediatric age group [ 92 , 94 ]. Hemophagocytic lymphohistiocytosis has often been reported in association with histoplasmosis infection in kidney transplant recipients and this complicates the management and often worsens the prognosis [ 50 , 92 , 94 ].…”

“…Studies have reported on occurrences of disseminated histoplasmosis in pediatric kidney transplant patients which are by far the commonest solid organ transplants done in the pediatric age group [ 92 , 94 ]. Hemophagocytic lymphohistiocytosis has often been reported in association with histoplasmosis infection in kidney transplant recipients and this complicates the management and often worsens the prognosis [ 50 , 92 , 94 ]. A case series of six pediatric kidney transplant patients in an endemic region of the USA put the attack rate of histoplasmosis among kidney transplant patients at 6.9/100 cases.…”

“…A case series of six pediatric kidney transplant patients in an endemic region of the USA put the attack rate of histoplasmosis among kidney transplant patients at 6.9/100 cases. One-third of the cases occurred in the first year following the kidney transplant and there were no fatalities [ 94 ]. Most of the patients were treated with amphotericin B and then transitioned to an azole, with 83% receiving chronic suppression therapy with itraconazole to prevent future occurrences, such therapy was usually given indefinitely.…”

“…Most of the patients were treated with amphotericin B and then transitioned to an azole, with 83% receiving chronic suppression therapy with itraconazole to prevent future occurrences, such therapy was usually given indefinitely. The authors suggested there may be a case for histoplasmosis prophylaxis for pediatric transplant recipients in endemic areas [ 94 ].…”