Diagnosis, treatment, and outcomes of coccidioidomycosis in allogeneic stem cell transplantation. Issue 3 (21st May 2015)

• Record Type: Journal Article
• Authors: Mendoza, N.; Noel, P.; Blair, J.E.
• Is Part Of: Transplant infectious disease. Volume 17:Issue 3(2015)
• Page Start: 380
• Page End: 388
• Publication Date: 2015-05-21
• Subjects: Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12372
• Languages: English
• ISSNs: 1398-2273

Abstract

<abstract abstract-type="main" id="tid12372-abs-0001"> <title>Abstract</title> <sec id="tid12372-sec-0001" sec-type="section"> <title>Background</title> <p>Allogeneic hematopoietic stem cell transplant (allo‐HSCT) recipients have multiple risk factors for coccidioidomycosis, and previous reports of coccidioidomycosis in this patient population describe severe infections with poor outcomes.</p> </sec> <sec id="tid12372-sec-0002" sec-type="section"> <title>Methods</title> <p>We performed a retrospective chart review of allo‐HSCT recipients with active coccidioidomycosis to characterize the utility of diagnostic tests for coccidioidomycosis and to determine treatment outcomes.</p> </sec> <sec id="tid12372-sec-0003" sec-type="section"> <title>Results</title> <p>Eleven of 426 (2.6%) allo‐HSCT recipients experienced active coccidioidomycosis after transplantation. Of these 11 patients, 1 (9%) had extrapulmonary infection, 9 (82%) patients were hospitalized, and 5 (45%) died. Culture or histology was positive in 33% (3/9) of the patients tested. Most (64% [7/11]) had at least 1 positive serologic test result, and the enzyme immunoassay immunoglobulin G test was positive most often (overall 55% [6/11]). Chest radiographs and chest computed tomography scans showed miliary or multifocal nodular infiltrates or consolidations, consistent with coccidioidomycosis, in 80% (8/10) and 100% (9/9), respectively, of patients tested throughout the course of active illness. Rapid polymerase chain reaction testing was positive in 71% (5/7) of the patients tested. Peripheral eosinophilia was present in 18% (2/11) of patients.</p> </sec> <sec id="tid12372-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Coccidioidomycosis is associated with high morbidity and mortality in allo‐HSCT recipients in an area endemic for <italic>Coccidioides</italic>. Diagnosis of this infection can be difficult and often requires multiple and frequently invasive tests. Antifungal prophylaxis should be considered for patients at highest risk.</p> </sec> </abstract>