TY - JOUR
T1 - Coccidioidomycosis Transmission Through Solid Organ Transplantation (2013–2022)
T2 - A Report of the Organ Procurement and Transplantation Network ad hoc Disease Transmission Advisory Committee
AU - Lee, Dong Heun
AU - Abidi, Maheen Z.
AU - Fisher, Cynthia
AU - Hughart, Anna L.
AU - Toda, Mitsuru
AU - Williams, Samantha
AU - Berry, Gerald J.
AU - Graves, Riki
AU - Handarova, Dzhuliyana
AU - Ho, Chak Sum
AU - Kittleson, Michelle
AU - Levi, Marilyn E.
AU - Livelli, Taylor
AU - Marboe, Charles C.
AU - Annamabhotla, Pallavi
AU - Miller, Rachel A.
AU - Sharma, Tanvi
AU - Sellers, Marty T.
AU - Taimur, Sarah
AU - Te, Helen S.
AU - Trindade, Anil J.
AU - Wood, R. Patrick
AU - Zaffiri, Lorenzo
AU - Pouch, Stephanie M.
AU - Danziger-Isakov, Lara
N1 - Publisher Copyright:
© 2024 Wiley Periodicals LLC.
PY - 2024
Y1 - 2024
N2 - Background: Coccidioidomycosis is a fungal infection that poses a serious risk when transmitted through organ transplantation. We analyzed cases reported to the Organ Procurement and Transplantation Network ad hoc Disease Transmission Advisory Committee from 2013 to 2022. Methods: Donors and/or recipients who had positive Coccidioides immitis/posadasii serology, pathology, and/or culture were included in this study. Cases adjudicated as ‘proven’ or ‘probable’ were analyzed for donor infection risk factors, the timing of infection, transmission by organ type, clinical manifestations, and recipient outcomes. Patient and facility identifiers were removed prior to review. Results: During this time period, 73 potential instances of Coccidioides donor disease transmission events were reported. Among them, infection was transmitted from seven deceased donors to eight recipients. All seven deceased donors had prior infection or exposure to regions where coccidioidomycosis is endemic. Of 20 individuals receiving organs from these donors, eight developed infection, resulting in a 40% transmission rate. The median time to diagnosis post-transplant was 39 days. Disseminated disease occurred in six recipients, five of whom died from the infection. Notably, none of the recipients who received prophylactic antifungal treatment died from the infection. Conclusion: Despite its rarity, donor-derived Coccidioides infection is a serious concern, particularly due to the high mortality rate in the early post-transplant period. To mitigate these risks, a thorough assessment of donor exposure history, coupled with donor serology and bronchoalveolar lavage cultures, can effectively guide post-transplant antifungal prophylaxis. Prompt reporting is crucial to prevent Coccidioides infections among other recipients. (Figure presented.).
AB - Background: Coccidioidomycosis is a fungal infection that poses a serious risk when transmitted through organ transplantation. We analyzed cases reported to the Organ Procurement and Transplantation Network ad hoc Disease Transmission Advisory Committee from 2013 to 2022. Methods: Donors and/or recipients who had positive Coccidioides immitis/posadasii serology, pathology, and/or culture were included in this study. Cases adjudicated as ‘proven’ or ‘probable’ were analyzed for donor infection risk factors, the timing of infection, transmission by organ type, clinical manifestations, and recipient outcomes. Patient and facility identifiers were removed prior to review. Results: During this time period, 73 potential instances of Coccidioides donor disease transmission events were reported. Among them, infection was transmitted from seven deceased donors to eight recipients. All seven deceased donors had prior infection or exposure to regions where coccidioidomycosis is endemic. Of 20 individuals receiving organs from these donors, eight developed infection, resulting in a 40% transmission rate. The median time to diagnosis post-transplant was 39 days. Disseminated disease occurred in six recipients, five of whom died from the infection. Notably, none of the recipients who received prophylactic antifungal treatment died from the infection. Conclusion: Despite its rarity, donor-derived Coccidioides infection is a serious concern, particularly due to the high mortality rate in the early post-transplant period. To mitigate these risks, a thorough assessment of donor exposure history, coupled with donor serology and bronchoalveolar lavage cultures, can effectively guide post-transplant antifungal prophylaxis. Prompt reporting is crucial to prevent Coccidioides infections among other recipients. (Figure presented.).
KW - Coccidioidomycosis
KW - antifungal prophylaxis
KW - donor-derived infection
KW - transplant
UR - http://www.scopus.com/inward/record.url?scp=85210375472&partnerID=8YFLogxK
U2 - 10.1111/tid.14406
DO - 10.1111/tid.14406
M3 - Article
AN - SCOPUS:85210375472
SN - 1398-2273
JO - Transplant Infectious Disease
JF - Transplant Infectious Disease
ER -