408. Disseminated Coccidioidomycosis prior to Transplantation is a Risk Factor for Reactivation after Solid Organ Transplantation
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Transplant (tx) recipients who become infected with Coccidioides have high rates of morbidity and mortality. Within the Coccidioides-endemic area, most coccidioidal infections in organ tx recipients are due to reactivation and not new acquisition. Risk factors for such reactivated infection include a documented history of coccidioidomycosis or a positive serology at or just prior to organ tx. Antifungal prophylaxis targeted to the organ recipients with these risk factors minimizes the risk of such reactivation following tx. We sought to define characteristics that increase the risk of post-tx coccidioidomycosis reactivation while receiving antifungal prophylaxis.
Methods: A retrospective chart review was conducted on all patients with a history of or positive serology for coccidioidomycosis prior to tx. Details regarding tx, immunosuppression and coccidioidal illness, prophylaxis and post-tx coccidioidal illness were abstracted.
Results: 70 patients receiving 76 organs had coccidioidomycosis prior to tx (40 kidney, 26 liver, 10 pancreas and 6 combined organ recipients). Mean age was 49 years, 73% Caucasian, 70% male. 40% had diabetes mellitus. 89% received standard prophylaxis for coccidioidomycosis. All received standard combination immunosuppression. 24% received treatment for organ rejection. 5 had a pre-tx history of disseminated coccidioidomycosis. Following tx, 4 patients had active coccidioidomycosis and 66 patients did not have reactivated coccidioidomycosis. When compared with patients whose coccidioidal illness remained quiescent, the cohort whose infection reactivated despite antifungal prophylaxis, were more likely to have disseminated coccidioidomycosis prior to tx (p=0.02). There were no significant differences in race, age, sex, type of organ transplanted, presence of diabetes mellitus, CMV mismatch, components of immunosuppression or a history of rejection.
Conclusion: Patients with disseminated coccidioidomycosis prior to tx are at increased risk of reactivated coccidioidal infection following organ tx even while receiving prophylaxis to prevent reactivation.
Janis Blair, MD1, Shimon Kusne, MD, Maria Teresa Seville, MD1, Holenarasipur Vikram, MD3 and  J. E. Blair, None..
S. Kusne, None..
H. R. Vikram, None..
M. Seville, None., (1)Division of Infectious Diseases Mayo Clinic Hospital, Phoenix, AZ, (2)Mayo Clinic Arizona, Phoenix, AZ