Coccidioidomycosis and Lung Transplantation

Vikram, Holenarasipur R.; Dosanjh, Amrita; Blair, Janis E.

doi:10.1097/tp.0b013e31822e6e9a

Cited by 30 publications

(21 citation statements)

References 35 publications

(43 reference statements)

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“…The lungs of an organ donor with active or previous coccidioidomycosis are likely to harbor organisms contained either in an area of inflammation or a granuloma (96). However, the precise risk of transmission from a previously infected donor via lung transplantation is not known.…”

Section: Prophylaxismentioning

confidence: 99%

“…However, the precise risk of transmission from a previously infected donor via lung transplantation is not known. Since the organisms can remain viable within a granuloma, some centers employ lifelong prophylaxis in lung transplant recipients (96). Organs other than lungs may or may not harbor Coccidioides, and unless there is gross or histopathological evidence of such infection in the donor organ, the risk of donor-derived coccidioidomycosis is unknown.…”

Section: Prophylaxismentioning

confidence: 99%

See 1 more Smart Citation

Donor-Derived Fungal Infections in Organ Transplant Recipients: Guidelines of the American Society of Transplantation, Infectious Diseases Community of Practice

Singh

Huprikar

Burdette

et al. 2012

American Journal of Transplantation

150

155

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Section: Prophylaxismentioning

confidence: 99%

Section: Prophylaxismentioning

confidence: 99%

Donor-Derived Fungal Infections in Organ Transplant Recipients: Guidelines of the American Society of Transplantation, Infectious Diseases Community of Practice

Singh

Huprikar

Burdette

et al. 2012

American Journal of Transplantation

150

155

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“…Among donors receiving allogeneic solid organ transplants within the region of endemicity, the incidence of active coccidioidomycosis currently appears to be below 5% (95)(96)(97)(98). It is presumed that 70% of cases are due to reactivation of a previously acquired infection (95,99), based on the observation that more than 50% of cases occur within 3 months of transplantation and 70% occur during the first year, a time of maximum immunosuppression (95).…”

Section: Specific Immune Deficits Associated With Coccidioidomycosismentioning

confidence: 99%

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

et al. 2013

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SUMMARY Coccidioidomycosis is the endemic mycosis caused by the fungal pathogens Coccidioides immitis and C. posadasii . This review is a summary of the recent advances that have been made in the understanding of this pathogen, including its mycology, genetics, and niche in the environment. Updates on the epidemiology of the organism emphasize that it is a continuing, significant problem in areas of endemicity. For a variety of reasons, the number of reported coccidioidal infections has increased dramatically over the past decade. While continual improvements in the fields of organ transplantation and management of autoimmune disorders and patients with HIV have led to dilemmas with concurrent infection with coccidioidomycosis, they have also led to advances in the understanding of the human immune response to infection. There have been some advances in therapeutics with the increased use of newer azoles. Lastly, there is an overview of the ongoing search for a preventative vaccine.

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“…The IL-12/IFN-␥ and Th1 axis of immunity appears to be critical for control of disseminated coccidioidomycosis in humans (51). Moreover, patients with HIV-1 infection or neutropenia due to chemotherapy or preparation for solid organ transplantation are at high risk of coccidioidomycosis (52,53). Many studies of pulmonary coccidioidomycosis have reported IFN-␥ production as a correlate of vaccine-induced protection in mice (54,55).…”

Section: Discussionmentioning

confidence: 99%

Card9- and MyD88-Mediated Gamma Interferon and Nitric Oxide Production Is Essential for Resistance to Subcutaneous Coccidioides posadasii Infection

2016

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Coccidioidomycosis is a potentially life-threatening respiratory disease which is endemic to the southwestern United States and arid regions of Central and South America. It is responsible for approximately 150,000 infections annually in the United States alone. Almost every human organ has been reported to harbor parasitic cells of Coccidioides spp. in collective cases of the disseminated form of this mycosis. Current understanding of the mechanisms of protective immunity against lung infection has been largely derived from murine models of pulmonary coccidioidomycosis. However, little is known about the nature of the host response to Coccidioides in extrapulmonary tissue. Primary subcutaneous coccidioidal infection is rare but has been reported to result in disseminated disease. Here, we show that activation of MyD88 and Card9 signal pathways are required for resistance to Coccidioides infection following subcutaneous challenge of C57BL/6 mice, which correlates with earlier findings of the protective response to pulmonary infection. MyD88 ؊/؊ and Card9 ؊/؊ mice recruited reduced numbers of T cells, B cells, and neutrophils to the Coccidioides-infected hypodermis compared to wild-type mice; however, neutrophils were dispensable for resistance to skin infection. Further studies have shown that gamma interferon (IFN-␥) production and activation of Th1 cells characterize resistance to subcutaneous infection. Furthermore, activation of a phagosomal enzyme, inducible nitric oxide synthase, which is necessary for NO production, is a requisite for fungal clearance in the hypodermis. Collectively, our data demonstrate that MyD88-and Card9-mediated IFN-␥ and nitric oxide production is essential for protection against subcutaneous Coccidioides infection.T wo species of Coccidioides, C. immitis and C. posadasii, are soilborne molds and the etiologic agents of coccidioidomycosis, a potentially life-threatening human respiratory disease that is also known as San Joaquin Valley fever. This pulmonary mycosis is endemic to the southwestern United States and certain arid regions of Mexico, as well as Central and South America (1). Recent evidence has revealed that C. posadasii occurs in Washington State, well north of the previously documented boundary of regions of endemicity for coccidioidal infections in the United States (2). Coccidioides is a diphasic pathogen, characterized by a saprobic phase that produces dry, air-dispersed, infectious spores from vegetative mycelia and a parasitic cycle which is unique among the medically important fungi (3). Inhaled spores grow isotropically in the lungs of the mammalian host to form the first generation of parasitic cells (spherule initials). The spherule initials continue to enlarge and differentiate into multinucleate spherules (Ͼ80 m in diameter). The cytoplasm of these coenocytes undergoes a process of segmentation by invagination of the inner spherule wall layer, followed by the formation of a multitude of endospores, each 2 to 10 m in diameter. Endospores also undergo isotropic...

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Coccidioidomycosis and Lung Transplantation

Cited by 30 publications

References 35 publications

Donor-Derived Fungal Infections in Organ Transplant Recipients: Guidelines of the American Society of Transplantation, Infectious Diseases Community of Practice

Donor-Derived Fungal Infections in Organ Transplant Recipients: Guidelines of the American Society of Transplantation, Infectious Diseases Community of Practice

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

Card9- and MyD88-Mediated Gamma Interferon and Nitric Oxide Production Is Essential for Resistance to Subcutaneous Coccidioides posadasii Infection

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