Single‐center experience of antifungal prophylaxis for coccidioidomycosis in heart transplant recipients within an endemic area

Abstract

In endemic regions, coccidioidomycosis causes substantial morbidity and mortality for patients receiving solid organ transplants. We aimed to demonstrate the effect of antifungal coccidioidal prophylaxis in heart transplant (HT) recipients. We retrospectively reviewed the electronic health records of all patients who received HTs between October 19, 2005, and December 13, 2014. We collected information regarding antifungal regimens and determined whether patients subsequently developed infections. Our 174-person cohort all received antifungal prophylaxis for at least 6 months (mean follow-up, 53.8 months). One proven and one probable coccidioidal infection (each, 0.6%) occurred during the study period. The incidence of coccidioidomycosis was 0.6% at 1 year and 2.3% at 5 years. No cases of proven coccidioidomycosis occurred within 2 years after transplantation. No patients developed disseminated disease, and no sentinel events were attributed to coccidioidomycosis. Both fluconazole and voriconazole were well tolerated. In the absence of intolerance or contraindication, we suggest continuing a universal antifungal prophylactic regimen with fluconazole for at least 6-12 months in HT recipients residing in a coccidioidomycosis-endemic area.

Epidemiology, risk factors, and association of antifungal prophylaxis on early invasive fungal infection in heart transplant recipients

“…Azole antifungal prophylaxis has previously been demonstrated to be effective for coccidioidomycosis 16 . Our cohort did include 3 cases of coccidioidomycosis out of the total 62 IFI in the first 12 months after transplantation, of which only one was on prophylaxis at the time of diagnosis.…”

“…At Mayo Clinic Arizona, heart transplant recipients routinely receive 6 months of an azole antifungal to prophylax against coccidioidomycosis 16 . At Mayo Clinic Rochester and Florida, systemic antifungal prophylaxis is not routine.…”

Screening Coccidioides serology in kidney transplant recipients: A 10‐year cross‐sectional analysis

“…In this strategy, antifungal prophylaxis is given to patients with a prior history of coccidioidomycosis or positive serological testing. There is, however, growing literature to support the use of universal prophylaxis, at least for patients living in highly endemic areas due to risk for de novo infection as reported by Blair et al and a universal prophylaxis strategy for transplant recipients from endemic areas is currently recommended by the IDSA. Blair et al.…”

“…For patients from highly endemic areas such as Bakersfield, we typically perform a universal prophylaxis strategy regardless of serologic testing. There have been reports of successful implementation of time‐limited universal prophylaxis for residents from highly endemic areas from Mayo Clinic Arizona . However, the generalizability of universal prophylaxis for patients from suspected, but less clearly endemic areas is not well established.…”

“…There have been reports of successful implementation of timelimited universal prophylaxis for residents from highly endemic areas from Mayo Clinic Arizona. 8,9 However, the generalizability of universal prophylaxis for patients from suspected, but less clearly endemic areas is not well established. This study aims to evaluate the prevalence of seropositivity for Coccidioides in kidney transplant recipients (KTRs) in order to inform strategies for screening and prophylaxis.…”