Diagnosis, treatment, and outcomes of coccidioidomycosis in allogeneic stem cell transplantation

Abstract

Coccidioidomycosis is associated with high morbidity and mortality in allo-HSCT recipients in an area endemic for Coccidioides. Diagnosis of this infection can be difficult and often requires multiple and frequently invasive tests. Antifungal prophylaxis should be considered for patients at highest risk.

Coccidioidomycosis among persons undergoing lung transplantation in the coccidioidal endemic region

“…The rate of coccidioidomycosis in this group is higher than that seen for other transplants performed in Arizona. It is unclear if this is a true difference, but lung transplant recipients may represent a unique group, because the lung is the most common portal of entry for the fungus.…”

Update on the Epidemiology of Coccidioidomycosis

“…Patients receiving allogeneic stem cell transplantations in Arizona were also reviewed in another study that noted active coccidioidomycosis after transplantation in 11 of 426 patients (2.6 %) [40]. Also taking place within Arizona, a retrospective study among liver transplant recipients noted a rate of 2.4 % [41].…”

“…The advent of and increasing use of immunomodulatory agents that target cell-mediated immunity is a trend that warrants increased awareness of healthcare providers on the risks o f c o c c i d i o i d o m y c o s i s i n t h e s e p o p u l a t i o n s . Chemotherapeutic agents and high-dose corticosteroids (equivalent to >20 mg/day prednisone) have traditionally been identified as conferring risk of infection; however, the increasing prevalence of tumor necrosis factor-α (TNF-α) antagonists along with immunosuppression accompanying solid organ or hematopoietic stem cell transplantation recipients is also of rising concern [38][39][40].…”

“…Unlike in those receiving TNF-α, the risk for reactivation of coccidioidomycosis appears to be greater among transplant recipients. For example, with regard to allogeneic stem cell transplantation, institutions within endemic areas recommend screening prior to transplantation in addition to azole prophylaxis for 1 year until engraftment occurs and all immunosuppressive medications have been discontinued [40]. This level of prophylaxis is provided to patients with no history of coccidioidomycosis and negative serology, although increasing durations of prophylaxis are recommended to be tailored for those with a history of, positive serology for, or active disease with coccidioidomycosis in consultation with an Infectious Diseases Specialist.…”

Enhanced Antibody Detection and Diagnosis of Coccidioidomycosis with the MiraVista IgG and IgM Detection Enzyme Immunoassay

“…Culture is the "gold standard," but culture results are positive in only about one-half of cases among immunocompromised patients and usually do not provide the initial basis for diagnosis. Additionally, cytopathology or histopathology results are positive for only 20 to 30% of immunocompromised patients (6)(7)(8)(9). Serological methods, including immunodiffusion (ID), complement fixation (CF), and enzyme immunoassay (EIA), provide the sensitivity and specificity (Table 1) and predictive values ( Table 2) are reported.…”