Pulmonary Coccidioidomycosis After a Renal Transplant in a Nonendemic Region

Abstract

Coccidioidomycosis is a fungal infection caused by the Coccidioides species, endemic to the southwestern United States. In healthy people, manifestations range mainly from asymptomatic to mild influenza-like signs, whereas in immunosuppressed patients (eg, transplant recipients) this infection is often a severe disseminated disease. We report a case of primary pulmonary coccidioidomycosis in a 61-year-old man with a renal transplant 7 months earlier. The patient had nonspecific symptoms of pulmonary infection, including weakness, anorexia, and weight loss. Both spherules and endospores of Coccidioides immitis were seen histologically after a transbronchial biopsy of a cavitary lesion. The patient was treated with amphotericin B. At the time of this writing (8 months), he remains disease free.

Donor‐derived endemic mycoses after solid organ transplantation: A review of reported cases

“…Twenty‐four cases of donor‐derived infection (DDI) due to endemic mycoses were identified (Table 1), from 18 publications reported through May 2023 6–23 . Of these, the majority (16 of 24; 66.7%) were coccidioidomycosis, 6–9,14–16,18–20,23 and there were also 7 (29.2%) cases of histoplasmosis, 10,12,13,17,21,22 and one case of talaromycosis 11 .…”

“…Twenty-four cases of donor-derived infection (DDI) due to endemic mycoses were identified (Table 1), from 18 publications reported through May 2023. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Of these, the majority (16 of 24; 66.7%) were coccidioidomycosis, [6][7][8][9][14][15][16][18][19][20]23 and there were also 7 (29.2%) cases of histoplasmosis, 10,12,13,17,21,22 and one case of talaromycosis. 11 We found no published reports of DDI due to blastomycosis or paracoccidioidomycosis in our comprehensive review.…”

“…6,9 Disseminated coccidiodomycosis was the most common clinical syndrome (12/16, 75%), 6,8,9,[14][15][16]18,23 while pulmonary infection was reported in two lung, 7,20 and one kidney transplant recipient. 19 There was one recipient who had asymptomatic serologic conversion which was detected because of close surveillance due to a suspected transmission event. 9 Chest imaging was performed for nine patients, 6,9,14,15,[18][19][20] and findings were variable (Table 2).…”

“…19 There was one recipient who had asymptomatic serologic conversion which was detected because of close surveillance due to a suspected transmission event. 9 Chest imaging was performed for nine patients, 6,9,14,15,[18][19][20] and findings were variable (Table 2).…”

Post-transplant pulmonary Coccidioidomycosis in a non-endemic area: Early diagnosis, the cornerstone for treatment of a life-threatening condition

“…Primary pulmonary coccidioidomycosis generally resolves spontaneously within 30-60 days, even without antifungal treatment, and patients retain lifelong immunity to exogenous infection [20,21]. In contrast, people with compromised immune systems such as patients with lymphoma, organ transplants or AIDS are more likely to develop severe pneumonia and disseminated infection [11,12,22,23] and particularly susceptible to chronic forms of pulmonary disease [24,25]. This disease is characterized by pulmonary cavitation but the lungs might also be diffusely affected because of the inhalation of a large quantity of infective arthroconidia or as a late and secondary presentation resulting from hematogenous dissemination.…”