Histoplasmosis, Coccidioidomycosis, and Diseases Due to Other Endemic Fungi in Transplant Recipients

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 organism from respiratory secretions, blood, other body fluids, or tissue. With appropriate stains, fungal organisms may be detected directly from clinical specimens. All immunocompromised patients should be treated, usually with a lipid formulation of amphotericin B followed by azole therapy. Donors and recipients should be evaluated for the possibility of active disease before transplantation. Because each endemic fungal infection is unusual outside of a specific geographic area, a careful travel and residence history should be obtained.