Approach to the solid organ transplant patient with latent infection and disease caused by Coccidioides species

Purpose of review As transplant programmes flourish within the desert southwestern United States where Coccidioides species are endemic, there is increased awareness of and experience in identifying at-risk patients, and in diagnosing and treating coccidioidal infections. This review summarizes recent findings of studies and case reports about coccidioidomycosis in transplant recipients. Recent findings Key to preventing posttransplantation coccidioidomycosis is identification of the at-risk population before transplantation. In transplant candidates, end-organ disease or comorbid conditions may mask or alter symptoms of infection; a high index of suspicion is therefore needed. With targeted prophylaxis, the rate of posttransplantation coccidioidal infections is low (1-3%); however, dissemination and mortality remain high (30 and 29%, respectively). The risk of donor-derived coccidioidomycosis is present but undefined. The diagnosis of coccidioidomycosis can be difficult, because of possible false-negative serologic findings in this population. Treatment in transplant patients parallels that for the general population, with additional secondary prophylaxis to prevent recurrence. Summary In this patient population, coccidioidomycosis is a serious infection deserving careful and continuous consideration. With appropriate prophylaxis strategies, providers treating patients with coccidioidal infection can minimize its rate. Future studies should address diagnostics, treatment, and prevention strategies.