Histoplasmosis in solid organ transplant recipients at a large Midwestern university transplant center

Alison Gail Freifeld, Peter Charles Iwen, B. L. Lesiak, R. K. Gilroy, R. B. Stevens, Andre C Kalil

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Histoplasma capsulatum sporadically causes severe infections in solid organ transplant (SOT) patients in the Midwest, but it has been an unusual infection among those patients followed at the University of Nebraska Medical Center (UNMC), located at the western edge of the 'histo belt.' Nine SOT patients with histoplasmosis are described (6 renal or renal-pancreas and 3 liver recipients) who developed severe histoplasmosis over a recent 2.5-year period at UNMC. Symptoms started a median of 11 months (range, 1.2-90 months) after organ transplant and consisted primarily of fever, cough, shortness of breath, and malaise or fatigue present for approximately 30 days prior to medical evaluation. All patients had an abnormal chest radiograph and/or computed tomographic scan. Tacrolimus was the main immunosuppressant in all 9 patients, along with prednisone or mycophenolate. Dacluzimab or thymoglobulin had been given around the time of transplant in 6 of 9. None was treated for an episode of acute rejection within 2 months before onset of histoplasmosis, although 2 were on high-dose immunosuppression after recent transplants. Diagnosis was made by culture in 8 of the 9 patients, with positive serum and urine histoplasma antigen tests in all 9 cases. From 1997 to 2001, during a period of relative quiescence of the disease in the general population, the rate of clinical histoplasmosis among SOT patients at UNMC was estimated at 0.11%, whereas during 2002 through the first half of 2004, the rate rose 17-fold to 1.9%. Histoplasmosis can present as a prolonged febrile illness with subacute pulmonary symptoms in a cohort of SOT patients, despite the absence of a regional outbreak.

Original languageEnglish (US)
Pages (from-to)109-115
Number of pages7
JournalTransplant Infectious Disease
Volume7
Issue number3-4
DOIs
StatePublished - Sep 1 2005

Fingerprint

Histoplasmosis
Transplants
Histoplasma
Fever
Kidney
Transplant Recipients
Tacrolimus
Immunosuppressive Agents
Prednisone
Infection
Cough
Dyspnea
Immunosuppression
Fatigue
Disease Outbreaks
Pancreas
Thorax
Urine
Antigens
Lung

Keywords

  • Histoplasmosis
  • Solid organ transplants

ASJC Scopus subject areas

  • Infectious Diseases
  • Transplantation

Cite this

Histoplasmosis in solid organ transplant recipients at a large Midwestern university transplant center. / Freifeld, Alison Gail; Iwen, Peter Charles; Lesiak, B. L.; Gilroy, R. K.; Stevens, R. B.; Kalil, Andre C.

In: Transplant Infectious Disease, Vol. 7, No. 3-4, 01.09.2005, p. 109-115.

Research output: Contribution to journalArticle

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