Updates on Histoplasmosis in Solid Organ Transplantation

Abstract

Purpose of review: Histoplasmosis remains a challenging infection in solid organ transplantation. This review provides a topic update with emphasis on the changing Histoplasma epidemiology, along with new diagnostic and treatment innovations.

Recent findings: Recent years have observed expanding Histoplasma geographic distribution due to climate change, environmental disruption, and host factors. Early clinical experience also suggests a relationship between COVID-19 infection and histoplasmosis, particularly among immunocompromised individuals. Advances in diagnostic methods, such as newer enzyme immunoassays and molecular techniques, have broadened the capability for expedient and highly specific pathogen identification. Novel drug innovations, including the development of new formulations of existing antifungal agents, extended-spectrum azoles and new antifungal drug classes have expanded therapeutic options.

Summary: Advances in organ transplantation have largely outpaced those for histoplasmosis. However, these emerging insights enhance our understanding of this pathogen and management of clinical infection, particularly for transplant recipients with a higher incidence and severity of disease.

Keywords: Antifungal therapy; COVID-19; Endemic mycoses; Histoplasmosis; Immunocompromised; Infection; Solid organ transplantation.

Fig. 1

Estimated areas of histoplasmosis worldwide. Legend: from reference [••] under a Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)