Endemic fungal infections in solid organ and hematopoietic cell transplant recipients enrolled in the Transplant-Associated Infection Surveillance Network (TRANSNET)

Abstract

Background: Invasive fungal infections are a major cause of morbidity and mortality among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients, but few data have been reported on the epidemiology of endemic fungal infections in these populations.

Methods: Fifteen institutions belonging to the Transplant-Associated Infection Surveillance Network prospectively enrolled SOT and HCT recipients with histoplasmosis, blastomycosis, or coccidioidomycosis occurring between March 2001 and March 2006.

Results: A total of 70 patients (64 SOT recipients and 6 HCT recipients) had infection with an endemic mycosis, including 52 with histoplasmosis, 9 with blastomycosis, and 9 with coccidioidomycosis. The 12-month cumulative incidence rate among SOT recipients for histoplasmosis was 0.102%. Occurrence of infection was bimodal; 28 (40%) infections occurred in the first 6 months post transplantation, and 24 (34%) occurred between 2 and 11 years post transplantation. Three patients were documented to have acquired infection from the donor organ. Seven SOT recipients with histoplasmosis and 3 with coccidioidomycosis died (16%); no HCT recipient died.

Conclusions: This 5-year multicenter prospective surveillance study found that endemic mycoses occur uncommonly in SOT and HCT recipients, and that the period at risk extends for years after transplantation.

Keywords: blastomycosis; coccidioidomycosis; hematopoietic cell transplant; histoplasmosis; solid organ transplant.

Fig. 1

Geographic distribution of cases of histoplasmosis, blastomycosis, and coccidioidomycosis reported from 15 transplant centers in the TRANSNET network.

Fig. 2

The 12-month cumulative incidence rate for histoplasmosis among solid ogan transplant recipients in the Incidence Cohort.

Fig. 3

Box and whisker graph indicating time in years to the diagnosis of an endemic mycosis among SOT and HCT recipients in the Surveillance Cohort. The box represents the interquartile range (25–75%). The total number of infections occurring ≤2 years post transplantation is listed in the left-hand column, and the total number of infections occurring >2 years post transplantation is listed in the right-hand column. The median time to the diagnosis of each infection is indicated by the dark vertical line within the box, and the thin vertical lines indicate the range. SOT, solid organ transplant; HCT, hematopoietic cell transplant; IFI, invasive fungal infection.