Histoplasmosis after solid organ transplant

Maha Assi, Stanley Martin, L. Joseph Wheat, Chadi Hage, Alison Freifeld, Robin Avery, John W. Baddley, Paschalis Vergidis, Rachel Miller, David Andes, Jo Anne H. Young, Kassem Hammoud, Shirish Huprikar, David McKinsey, Thein Myint, Julia Garcia-Diaz, Eden Esguerra, E. J. Kwak, Michele Morris, Kathleen M. MullaneVidhya Prakash, Steven D. Burdette, Mohammad Sandid, Jana Dickter, Darin Ostrander, Smyrna Abou Antoun, Daniel R. Kaul

Research output: Contribution to journalArticle

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Abstract

Background. To improve our understanding of risk factors, management, diagnosis, and outcomes associated with histoplasmosis after solid organ transplant (SOT), we report a large series of histoplasmosis occurring after SOT. Methods. All cases of histoplasmosis in SOT recipients diagnosed between 1 January 2003 and 31 December 2010 at 24 institutions were identified. Demographic, clinical, and laboratory data were collected. Results. One hundred fifty-two cases were identified: kidney (51%), liver (16%), kidney/pancreas (14%), heart (9%), lung (5%), pancreas (2%), and other (2%). The median time from transplant to diagnosis was 27 months, but 34% were diagnosed in the first year after transplant. Twenty-eight percent of patients had severe disease (requiring intensive care unit admission); 81% had disseminated disease. Urine Histoplasma antigen detection was the most sensitive diagnostic method, positive in 132 of 142 patients (93%). An amphotericin formulation was administered initially to 73% of patients for a median duration of 2 weeks; step-down therapy with an azole was continued for a median duration of 12 months. Ten percent of patients died due to histoplasmosis with 72% of deaths occurring in the first month after diagnosis; older age and severe disease were risk factors for death from histoplasmosis. Relapse occurred in 6% of patients. Conclusions. Although late cases occur, the first year after SOT is the period of highest risk for histoplasmosis. In patients who survive the first month after diagnosis, treatment with an amphotericin formulation followed by an azole for 12 months is usually successful, with only rare relapse.

Original languageEnglish (US)
Pages (from-to)1542-1549
Number of pages8
JournalClinical Infectious Diseases
Volume57
Issue number11
DOIs
StatePublished - Dec 1 2013

Fingerprint

Histoplasmosis
Transplants
Azoles
Amphotericin B
Pancreas
Histoplasma
Kidney
Recurrence
Risk Management
Intensive Care Units
Demography
Urine
Antigens
Lung
Liver
Therapeutics

Keywords

  • Fungal infection
  • Histoplasmosis
  • Solid organ transplant

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Assi, M., Martin, S., Wheat, L. J., Hage, C., Freifeld, A., Avery, R., ... Kaul, D. R. (2013). Histoplasmosis after solid organ transplant. Clinical Infectious Diseases, 57(11), 1542-1549. https://doi.org/10.1093/cid/cit593

Histoplasmosis after solid organ transplant. / Assi, Maha; Martin, Stanley; Wheat, L. Joseph; Hage, Chadi; Freifeld, Alison; Avery, Robin; Baddley, John W.; Vergidis, Paschalis; Miller, Rachel; Andes, David; Young, Jo Anne H.; Hammoud, Kassem; Huprikar, Shirish; McKinsey, David; Myint, Thein; Garcia-Diaz, Julia; Esguerra, Eden; Kwak, E. J.; Morris, Michele; Mullane, Kathleen M.; Prakash, Vidhya; Burdette, Steven D.; Sandid, Mohammad; Dickter, Jana; Ostrander, Darin; Antoun, Smyrna Abou; Kaul, Daniel R.

In: Clinical Infectious Diseases, Vol. 57, No. 11, 01.12.2013, p. 1542-1549.

Research output: Contribution to journalArticle

Assi, M, Martin, S, Wheat, LJ, Hage, C, Freifeld, A, Avery, R, Baddley, JW, Vergidis, P, Miller, R, Andes, D, Young, JAH, Hammoud, K, Huprikar, S, McKinsey, D, Myint, T, Garcia-Diaz, J, Esguerra, E, Kwak, EJ, Morris, M, Mullane, KM, Prakash, V, Burdette, SD, Sandid, M, Dickter, J, Ostrander, D, Antoun, SA & Kaul, DR 2013, 'Histoplasmosis after solid organ transplant', Clinical Infectious Diseases, vol. 57, no. 11, pp. 1542-1549. https://doi.org/10.1093/cid/cit593
Assi M, Martin S, Wheat LJ, Hage C, Freifeld A, Avery R et al. Histoplasmosis after solid organ transplant. Clinical Infectious Diseases. 2013 Dec 1;57(11):1542-1549. https://doi.org/10.1093/cid/cit593
Assi, Maha ; Martin, Stanley ; Wheat, L. Joseph ; Hage, Chadi ; Freifeld, Alison ; Avery, Robin ; Baddley, John W. ; Vergidis, Paschalis ; Miller, Rachel ; Andes, David ; Young, Jo Anne H. ; Hammoud, Kassem ; Huprikar, Shirish ; McKinsey, David ; Myint, Thein ; Garcia-Diaz, Julia ; Esguerra, Eden ; Kwak, E. J. ; Morris, Michele ; Mullane, Kathleen M. ; Prakash, Vidhya ; Burdette, Steven D. ; Sandid, Mohammad ; Dickter, Jana ; Ostrander, Darin ; Antoun, Smyrna Abou ; Kaul, Daniel R. / Histoplasmosis after solid organ transplant. In: Clinical Infectious Diseases. 2013 ; Vol. 57, No. 11. pp. 1542-1549.
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AU - Assi, Maha

AU - Martin, Stanley

AU - Wheat, L. Joseph

AU - Hage, Chadi

AU - Freifeld, Alison

AU - Avery, Robin

AU - Baddley, John W.

AU - Vergidis, Paschalis

AU - Miller, Rachel

AU - Andes, David

AU - Young, Jo Anne H.

AU - Hammoud, Kassem

AU - Huprikar, Shirish

AU - McKinsey, David

AU - Myint, Thein

AU - Garcia-Diaz, Julia

AU - Esguerra, Eden

AU - Kwak, E. J.

AU - Morris, Michele

AU - Mullane, Kathleen M.

AU - Prakash, Vidhya

AU - Burdette, Steven D.

AU - Sandid, Mohammad

AU - Dickter, Jana

AU - Ostrander, Darin

AU - Antoun, Smyrna Abou

AU - Kaul, Daniel R.

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N2 - Background. To improve our understanding of risk factors, management, diagnosis, and outcomes associated with histoplasmosis after solid organ transplant (SOT), we report a large series of histoplasmosis occurring after SOT. Methods. All cases of histoplasmosis in SOT recipients diagnosed between 1 January 2003 and 31 December 2010 at 24 institutions were identified. Demographic, clinical, and laboratory data were collected. Results. One hundred fifty-two cases were identified: kidney (51%), liver (16%), kidney/pancreas (14%), heart (9%), lung (5%), pancreas (2%), and other (2%). The median time from transplant to diagnosis was 27 months, but 34% were diagnosed in the first year after transplant. Twenty-eight percent of patients had severe disease (requiring intensive care unit admission); 81% had disseminated disease. Urine Histoplasma antigen detection was the most sensitive diagnostic method, positive in 132 of 142 patients (93%). An amphotericin formulation was administered initially to 73% of patients for a median duration of 2 weeks; step-down therapy with an azole was continued for a median duration of 12 months. Ten percent of patients died due to histoplasmosis with 72% of deaths occurring in the first month after diagnosis; older age and severe disease were risk factors for death from histoplasmosis. Relapse occurred in 6% of patients. Conclusions. Although late cases occur, the first year after SOT is the period of highest risk for histoplasmosis. In patients who survive the first month after diagnosis, treatment with an amphotericin formulation followed by an azole for 12 months is usually successful, with only rare relapse.

AB - Background. To improve our understanding of risk factors, management, diagnosis, and outcomes associated with histoplasmosis after solid organ transplant (SOT), we report a large series of histoplasmosis occurring after SOT. Methods. All cases of histoplasmosis in SOT recipients diagnosed between 1 January 2003 and 31 December 2010 at 24 institutions were identified. Demographic, clinical, and laboratory data were collected. Results. One hundred fifty-two cases were identified: kidney (51%), liver (16%), kidney/pancreas (14%), heart (9%), lung (5%), pancreas (2%), and other (2%). The median time from transplant to diagnosis was 27 months, but 34% were diagnosed in the first year after transplant. Twenty-eight percent of patients had severe disease (requiring intensive care unit admission); 81% had disseminated disease. Urine Histoplasma antigen detection was the most sensitive diagnostic method, positive in 132 of 142 patients (93%). An amphotericin formulation was administered initially to 73% of patients for a median duration of 2 weeks; step-down therapy with an azole was continued for a median duration of 12 months. Ten percent of patients died due to histoplasmosis with 72% of deaths occurring in the first month after diagnosis; older age and severe disease were risk factors for death from histoplasmosis. Relapse occurred in 6% of patients. Conclusions. Although late cases occur, the first year after SOT is the period of highest risk for histoplasmosis. In patients who survive the first month after diagnosis, treatment with an amphotericin formulation followed by an azole for 12 months is usually successful, with only rare relapse.

KW - Fungal infection

KW - Histoplasmosis

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