ABSTRACT
Coccidioidomycosis is geographically restricted mycosis that is responsible for substantial morbidity and mortality in solid organ transplant recipients (SOTRs) (1-30). While occurring less commonly than histoplasmosis in organ transplant recipients, coccidioidomycosis is a far more serious disease with a reported mortality in excess of 60% in some series (8,23,31). In SOTRs, coccidioidmycosis can occur from a few weeks to several months after transplantation and also as long as years following transplantation. In nonimmunocompromised patients, coccidioidomycosis can result in a clinically unapparent disease, a mild respiratory illness with a self-limited course, or in the development of pneumonia with or without disseminated disease depending on individual risk factors (21). Disseminated coccidioidomycosis extending beyond the pulmonary parenchyma or hilar lymph nodes occurs in <1% of the general population (1,11,17,18,20,30). Complications including protracted or complicated pulmonary disease or extrapulmonary disease and dissemination are infrequent, but are responsible for the substantial public health impact of this disease.Although respiratory tract disease canaffect any individual, disseminated coccidioidomycosis is more frequent in males, Filipinos, blacks, pregnant patients,Hispanics, and immunosuppressed patients (15,21). African Americans more often develop disseminated osseous disease
while Filipinos manifest cutaneous or central nervous system (CNS) disease. Pregnancy, blood type, human leukocyte antigen (HLA) type, diabetesmellitus, immunocompromised states including human immunodeficiency virus infection, hematologicalmalignancies, andorgan transplantationhave been reported as risk factors for disseminated disease (5,15,21,24,30-35). Notably, disease relapse is common in organ transplant recipients after apparently successful therapy and cessation of the antifungal agent (36).
