409. Histoplasmosis in Solid Organ Transplant Recipients
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Histoplasmosis (histo) is an uncommon infection in SOTs. We reviewed all cases of histo in the SOT population from 2003-2009 in order to better understand risk factors for infection, diagnosis, infected organ systems, treatment modalities and outcomes.
Methods: Retrospective analysis of histo in SOTs hospitalized at UAB from Jan. 2003-Jan. 2009. Data on demographics, transplant type, clinical presentation, site of disease, diagnosis, treatment and outcomes were collected. Primary outcome of interest was survival at 1-year post diagnosis.
Results: 15 cases of histo were identified. Mean age was 41.7 yrs, and 67 % were male. Transplant type included: 8 kidney, 3 liver, 2 kidney-pancreas, 1 heart, and 1 lung. Mean time to infection from transplant was 24.4 mos (range, 2 to 67mos). Nine (60%) of 15 had disseminated disease and 6 (40%) of 15 had pulmonary disease only. Organ systems involved included: lungs (87%), bone marrow (33%), spleen (40%), liver (33%), and CNS (7%). The most common findings at presentation were fever in 12(80%) of 15, and chest imaging with interstitial infiltrates or nodular disease, in 69%. Urine histoplasma antigen was positive in 14 (93%) of 15 patients; blood cultures were positive in 6(40%) patients. Initial therapy consisted of amphotericin B (AmB) in 80% (10 treated with lipid AmB) and itraconazole in 20%. Initial AmB was administered for a mean of 16.3 days. Itraconazole maintenance therapy continued for a mean of 9.8 months (range 4-14 months). Of 11 patients with follow-up data available at 1 year, all were alive and 90.9 % considered cured at 12 months. 2 patients were loss to follow-up and 2 have been treated successfully at 6 months.
Conclusions: Histo is an endemic mycosis uncommonly seen in the SOTs. Most infections were disseminated at presentation, and occasionally occurred within 6 mos of transplantation(20% in our series), suggesting possible donor transmission. Long-term outcomes were generally good after prolonged antifungal therapy.
John Baddley, MD, MSPH, Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, Matthew McCall, MD, University of Alabama at Birmingham, Birmingham, AL, Peter Pappas, MD, Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL and  M. J. McCall, None. 
P. Pappas,
Merck Role(s): Consultant, Grant Investigator, Research Relationship, Received: Grant Recipient, Research Grant, Speaker Honorarium.
Pfizer Role(s): Research Relationship, Received: Research Grant.
Astella Role(s): Research Relationship, Received: Research Grant.
Schering- Plough Role(s): Research Relationship, Received: Research Grant.
Novartis Role(s): Consultant, Received: Speaker Honorarium.
Basilea Role(s): Consultant, Received: Speaker Honorarium.
J. Baddley,
Merck Role(s): Research Relationship, Received: Research Grant.
Astellas Role(s): Research Relationship, Received: Research Grant.
Pfizer Role(s): Research Relationship, Received: Research Grant.
Enzon Role(s): Consultant, Received: Speaker Honorarium.