Endemic fungal infections in solid organ and hematopoietic cell transplant recipients enrolled in the Transplant‐Associated Infection Surveillance Network (TRANSNET)

Abstract

Background Invasive fungal infections are a major cause of morbidity and mortality among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients, but few data have been reported on the epidemiology of endemic fungal infections in these populations. Methods Fifteen institutions belonging to the Transplant-Associated Infection Surveillance Network prospectively enrolled SOT and HCT recipients with histoplasmosis, blastomycosis, or coccidioidomycosis occurring between March 2001 and March 2006. Results A total of 70 patients (64 SOT recipients and 6 HCT recipients) had infection with an endemic mycosis, including 52 with histoplasmosis, 9 with blastomycosis, and 9 with coccidioidomycosis. The 12-month cumulative incidence rate among SOT recipients for histoplasmosis was 0.102%. Occurrence of infection was bimodal; 28 (40%) infections occurred in the first 6 months post transplantation, and 24 (34%) occurred between 2 and 11 years post transplantation. Three patients were documented to have acquired infection from the donor organ. Seven SOT recipients with histoplasmosis and 3 with coccidioidomycosis died (16%); no HCT recipient died. Conclusions This 5-year multicenter prospective surveillance study found that endemic mycoses occur uncommonly in SOT and HCT recipients, and that the period at risk extends for years after transplantation.

The Global Burden of Fungal Diseases

“…36 One study evaluating a random sample of US Medicare data reported an incidence of 6.1 cases per 100,000 person-years in the Midwest during 1999 to 2008. 37 The actual burden in the United States is unknown outside of a few states because histoplasmosis is not nationally notifiable.…”

The Neurology of Solid Organ Transplantation

“…Environmental exposure in endemic areas may precipitate coccidioidomycosis (southwestern United States) or histoplasmosis (Mississippi Valley), and travel history is helpful to document possible exposure to rare fungi [43].…”

Fungal Pneumonia in Patients with Hematologic Malignancy and Hematopoietic Stem Cell Transplantation

“…No large epidemiologic registry of endemic fungal pneumonia in HM patients exists, though smaller studies suggest that HM patients develop endemic fungal pneumonias substantially more often than the general population 4,10 , and that these infections are more likely to be severe and/or lethal 8 . Interestingly, Transplant-Associated Infection Surveillance Network (TRANSNET) data suggest a very low rate of endemic fungal pneumonias in HSCT patients, potentially due to aggressive exposure avoidance during peak vulnerability 11 .…”