TY  - JOUR
AU  - Beaird, Omer
AU  - Nanayakkara, Deepa
AU  - Gaynor, Pryce
AU  - Schaenman, Joanna
PY  - 2019
DA  - 2019/07/26
TI  - Endemic Mycoses and Cryptococcus in Solid Organ Transplant Recipients
JO  - OBM Transplantation
SP  - 075
VL  - 03
IS  - 03
AB  - The endemic mycoses are an important cause of morbidity and mortality in transplant recipients.  These fungal infections are notable for a dimorphic life cycle, a specific geographic distribution, and typical infection via environmental exposure.  Their nonspecific presentation, often mimicking other infections, can make diagnosis challenging.  An important cause of infection is Coccidioides spp., which is endemic to the southwest of the United States and can cause severe pneumonia or meningitis, as well as bone and joint infection. Coccidioidomycosis is unique in that it is more likely to reactivate after immunosuppression compared with other endemic fungal infections, and recipients may benefit from secondary prophylaxis to prevent reactivation.  Like other fungal infections, it may be transmitted as a donor derived infection or occur as a primary infection.  Histoplasmosis is typically found in the Mississippi and Ohio River valleys in North America but can also be found worldwide, and can cause pneumonia, skin infection, and disseminated disease.  Blastomyces has an overlapping geographic distribution with Histoplasma spp. but is a less commonly seen infection, which can involve lung, skin, and bone.  Cryptococcus does not have a dimorphic form, but is found in the environment and has a presentation similar to the endemic fungi, and is therefore also discussed in this review.  Amphotericin B and the azole antifungals are commonly used to treat or prevent these infections, however, despite the availability of effective therapy, delays in diagnosis can result in adverse clinical outcomes.  Their geographic association makes the assessment of patient history for both donors and recipients increasingly important.  Hopefully, diagnostic methods will continue to advance, improving outcomes for transplant patients at risk for endemic fungal infections.
SN  - 2577-5820
UR  - https://doi.org/10.21926/obm.transplant.1903075
DO  - 10.21926/obm.transplant.1903075
ID  - Beaird2019
ER  -