Approach to the solid organ transplant patient with latent infection and disease caused by Coccidioides species.

PURPOSE OF REVIEW: As transplant programmes flourish within the desert southwestern United States where Coccidioides species are endemic, there is increased awareness of and experience in identifying at-risk patients, and in diagnosing and treating coccidioidal infections. This review summarizes recent findings of studies and case reports about coccidioidomycosis in transplant recipients.

RECENT FINDINGS: Key to preventing posttransplantation coccidioidomycosis is identification of the at-risk population before transplantation. In transplant candidates, end-organ disease or comorbid conditions may mask or alter symptoms of infection; a high index of suspicion is therefore needed. With targeted prophylaxis, the rate of posttransplantation coccidioidal infections is low (1-3%); however, dissemination and mortality remain high (30 and 29%, respectively). The risk of donor-derived coccidioidomycosis is present but undefined. The diagnosis of coccidioidomycosis can be difficult, because of possible false-negative serologic findings in this population. Treatment in transplant patients parallels that for the general population, with additional secondary prophylaxis to prevent recurrence.

SUMMARY: In this patient population, coccidioidomycosis is a serious infection deserving careful and continuous consideration. With appropriate prophylaxis strategies, providers treating patients with coccidioidal infection can minimize its rate. Future studies should address diagnostics, treatment, and prevention strategies.