Donor-Related Coccidioidomycosis in Organ Transplant Recipients

Abstract

Most cases of coccidioidomycosis in organ transplant recipients arise from either primary infection with Coccidioides immitis after environmental exposure or from reactivation of latent infection. Herein, we report 2 cases of rapidly fatal, disseminated coccidioidomycosis that occurred in organ transplant recipients who had never lived in or visited an area where C. immitis is endemic. Both subjects had received a transplanted organ from the same donor, an individual with unrecognized active coccidioidomycosis at the time of his death.

Transmission of Tropical and Geographically Restricted Infections during Solid-Organ Transplantation

“…Coccidioidomycoses complicating the postoperative course of renal, heart/heart-lung, liver, or small bowel transplant recipients have been reported (32,34,35,43,249,368,405).…”

“…Reports of transmission due to infected donor lungs, liver, and kidneys have been published (249,368,405). In all these cases, coccidioidal infection developed in the early posttransplant period.…”

“…The donor had been born in Arizona, and a postmortem study confirmed C. immitis in a lymph node (368). Wright et al described two cases (in a liver recipient and a kidney recipient) of rapidly fatal, disseminated coccidioidomycosis that occurred in organ transplant recipients who had never visited or lived in an area where C. immitis is endemic (405). Both subjects had received an organ from the same donor, an individual with unrecognized active coccidioidomycosis at the time of death (405).…”

“…Wright et al described two cases (in a liver recipient and a kidney recipient) of rapidly fatal, disseminated coccidioidomycosis that occurred in organ transplant recipients who had never visited or lived in an area where C. immitis is endemic (405). Both subjects had received an organ from the same donor, an individual with unrecognized active coccidioidomycosis at the time of death (405). Postmortem examination of liver and kidneys appeared to be normal, and these had been harvested for transplantation.…”

Fungal Infections in Transplant and Oncology Patients

“…Even in endemic regions, C. immitus infection is rarely encountered in the HSCT population [64] and most descriptions are in SOT recipients [65]. Unfortunately, as with the other endemic mycoses in the immunosuppressed population, dissemination is common, mortality is high (up to 72%), and infection can be transmitted via donated organs [66].…”