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Blastomycosis is a fungal infection caused primarily by Blastomyces dermatitis. The fungus is endemic to the Ohio, Mississippi, and St. Lawrence River areas of the United States. Organ transplant recipients are at risk of blastomycosis due to pharmacologic immunosuppression. Over a 20-year period, 30 cases of blastomycosis post-solid organ transplantation were identified at our center. The cumulative incidence of blastomycosis among SOT recipients was 0.99%. There was a male predominance...
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The endemic fungi are a group of thermally dimorphic fungi that occupy specific defined environmental ranges. They count Histoplasma, Blastomyces, Paracoccidioides, Coccidioides, Talaromyces, Emergomyces, and Sporothrix among their number. In the environment, they exist as molds, and at body temperature, they transform into their pathogenic yeast form (or, in the case of coccidioidomycosis, into a specialized structure called a spherule). Histoplasma, Blastomyces, and Paracoccidioides are...
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Coccidioidomycosis is an infection due to the fungal species Coccidioides, which is most heavily endemic in the desert southwestern USA. Although early studies of this infection among transplant recipients in the endemic region were complicated by high morbidity and mortality, solid organ and hematologic stem cell transplantation can be a successful undertaking within the Coccidioides-endemic region. Such success has been attributed to careful attention to screening for and treatment of...
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BACKGROUND: Itraconazole is the preferred azole for histoplasmosis in the current Infectious Diseases Society of America guidelines. Voriconazole is increasingly used as treatment for histoplasmosis; it has in-vitro activity against Histoplasma capsulatum and has shown success in case reports and small case series but may have a lower barrier to resistance. No comparative studies have been published. METHODS: We constructed a single-center retrospective cohort of adult patients diagnosed...
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These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention and management of blastomycosis, histoplasmosis, and coccidioidomycosis in the pre- and post-transplant period. Though each of these endemic fungal infections has unique epidemiology and clinical manifestations, they all share a predilection for primary pulmonary infection and may cause disseminated infection, particularly in...
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Endemic fungi are thermally dimorphic and occur naturally in specific geographic areas. Histoplasmosis, coccidioidomycosis, and blastomycosis are the three major disease entities encountered in North America. Even in endemic areas, disease incidence is low among transplant recipients. Infection is typically acquired via inhalation of molds from the environment. Disseminated infection is more likely to occur in immunocompromised individuals. Definitive diagnosis is established by growing the...
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Background Kidney transplant recipients (KTRs) are at risk for reactivation and complicated infection due to Coccidioides. Pre-transplant serological screening should provide benefit for patients from endemic areas. We evaluated Coccidioides seroprevalence by area of residence in KTRs at a major transplant program in Los Angeles. Methods We performed cross-sectional analyses of adult KTRs who underwent transplantation at UCLA between 2007-2016. Patients with Coccidioides serology by enzyme...
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The diagnosis of histoplasmosis is based on a multifaceted approach that includes clinical, radiographic, and laboratory evidence of disease. The gold standards for laboratory diagnosis include demonstration of yeast on pathological examination of tissue and isolation of the mold in the culture of clinical specimens; however, antigen detection has provided a rapid, noninvasive, and highly sensitive method for diagnosis and is a useful marker of treatment response. Molecular methods with...
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Donor-derived coccidioidomycosis has caused unexpected morbidity and mortality in transplant recipients. All proven or probable reports of donor-derived coccidioidomycosis to the Disease Transmission Advisory Committee between 2005 and August 2012 were reviewed. Six reports of proven or probable coccidioidomycosis were discovered. In four of six, the infection was first detected at autopsy in the recipient. In two cases it was first identified in the donor. Twenty-one recipients received...
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Summary: Fungal infections are becoming more frequent because of expansion of at-risk populations and the use of treatment modalities that permit longer survival of these patients. Because histopathologic examination of tissues detects fungal invasion of tissues and vessels as well as the host reaction to the fungus, it is and will remain an important tool to define the diagnostic significance of positive culture isolates or results from PCR testing. However, there are very few instances...
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In recent years, the increasing number of donors from different regions of the world is providing a new challenge for the management and selection of suitable donors. This is a worldwide problem in most countries with transplantation programs, especially ...
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Synonyms North American histoplasmosis. Contrast with African histoplasmosis due to Histoplasma duboisii Definition Histoplasmosis refers to the condition caused by the infection with the dimorphic endemic fungi N/A(L):Histoplasma capsulatum var. capsulatum. This anamorphic fungus has a known sexual teleomorph that carries the name Ajellomyces capsulatus. The majority of acute cases of infection with this fungus follow a subclinical and benign course in normal hosts [2412]. However, a...
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