Endemic fungal infections in solid organ and hematopoietic cell transplant recipients enrolled in the Transplant-Associated Infection Surveillance Network (TRANSNET)

• Type of Material: Article
• Authors: C.A. Kauffman, University of Michigan; A.G. Freifeld, University of Nebraska; D.R. Andes, University of Wisconsin; J.W. Baddley, University of Alabama Birmingham; L. Herwaldt, University of Iowa; R.C. Walker, Mayo Clinic; B.D. Alexander, Duke University; E.J. Anaissie, University of Arkansas; K. Benedict, Centers for Disease Control and Prevention; J.I. Ito, City of Hope Comprehensive Cancer Center; K.M. Knapp, St. Jude Children’s Research Hospital; George Lyon III, Emory University; K.A. Marr, Fred Hutchinson Cancer Research Center; V.A. Morrison, University of Minnesota; B.J. Park, Centers for Disease Control and Prevention; T.F. Patterson, University of Texas; M.G. Schuster, University of Pennsylvania; Tom Chiller, Emory University; P.G. Pappas, University of Alabama Birmingham
• Language: English
• Date: 2014-04-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1111/tid.12186
• Title of Journal or Parent Work: Transplant Infectious Disease
• ISSN: 1398-2273
• Volume: 16
• Issue: 2
• Start Page: 213
• End Page: 224
• Grant/Funding Information: This study was supported through CDC Grant 5U01CI000286-05 and grants from Merck & Co., Inc.; Astellas US, Inc.; Pfizer, Inc.; Schering-Plough Research Institute; and Enzon Pharmaceuticals, Inc.
• Keywords: CLINICAL-PRACTICE GUIDELINES; histoplasmosis; TRANSMISSION; BLASTOMYCOSIS; COCCIDIOIDOMYCOSIS; solid organ transplant; SOCIETY-OF-AMERICA; hematopoietic cell transplant; Transplantation; Science & Technology; UPDATE; MANAGEMENT; IMMUNOLOGY; INFECTIOUS DISEASES; blastomycosis; HISTOPLASMOSIS; Life Sciences & Biomedicine; Infectious Diseases; Immunology; TRANSPLANTATION; coccidioidomycosis
• Research Categories: Health Sciences, Immunology; Health Sciences, Epidemiology

Abstract

Background: Invasive fungal infections are a major cause of morbidity and mortality among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients, but few data have been reported on the epidemiology of endemic fungal infections in these populations. Methods: Fifteen institutions belonging to the Transplant-Associated Infection Surveillance Network prospectively enrolled SOT and HCT recipients with histoplasmosis, blastomycosis, or coccidioidomycosis occurring between March 2001 and March 2006. Results: A total of 70 patients (64 SOT recipients and 6 HCT recipients) had infection with an endemic mycosis, including 52 with histoplasmosis, 9 with blastomycosis, and 9 with coccidioidomycosis. The 12-month cumulative incidence rate among SOT recipients for histoplasmosis was 0.102%. Occurrence of infection was bimodal; 28 (40%) infections occurred in the first 6 months post transplantation, and 24 (34%) occurred between 2 and 11 years post transplantation. Three patients were documented to have acquired infection from the donor organ. Seven SOT recipients with histoplasmosis and 3 with coccidioidomycosis died (16%); no HCT recipient died. Conclusions: This 5-year multicenter prospective surveillance study found that endemic mycoses occur uncommonly in SOT and HCT recipients, and that the period at risk extends for years after transplantation.