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Histoplasmosis after solid organ transplant.

Publication ,  Journal Article
Assi, M; Martin, S; Wheat, LJ; Hage, C; Freifeld, A; Avery, R; Baddley, JW; Vergidis, P; Miller, R; Andes, D; Young, J-AH; Hammoud, K ...
Published in: Clin Infect Dis
December 2013

BACKGROUND: To improve our understanding of risk factors, management, diagnosis, and outcomes associated with histoplasmosis after solid organ transplant (SOT), we report a large series of histoplasmosis occurring after SOT. METHODS: All cases of histoplasmosis in SOT recipients diagnosed between 1 January 2003 and 31 December 2010 at 24 institutions were identified. Demographic, clinical, and laboratory data were collected. RESULTS: One hundred fifty-two cases were identified: kidney (51%), liver (16%), kidney/pancreas (14%), heart (9%), lung (5%), pancreas (2%), and other (2%). The median time from transplant to diagnosis was 27 months, but 34% were diagnosed in the first year after transplant. Twenty-eight percent of patients had severe disease (requiring intensive care unit admission); 81% had disseminated disease. Urine Histoplasma antigen detection was the most sensitive diagnostic method, positive in 132 of 142 patients (93%). An amphotericin formulation was administered initially to 73% of patients for a median duration of 2 weeks; step-down therapy with an azole was continued for a median duration of 12 months. Ten percent of patients died due to histoplasmosis with 72% of deaths occurring in the first month after diagnosis; older age and severe disease were risk factors for death from histoplasmosis. Relapse occurred in 6% of patients. CONCLUSIONS: Although late cases occur, the first year after SOT is the period of highest risk for histoplasmosis. In patients who survive the first month after diagnosis, treatment with an amphotericin formulation followed by an azole for 12 months is usually successful, with only rare relapse.

Duke Scholars

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

December 2013

Volume

57

Issue

11

Start / End Page

1542 / 1549

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Risk Factors
  • Retrospective Studies
  • Organ Transplantation
  • Middle Aged
  • Microbiology
  • Male
  • Immunocompromised Host
 

Citation

APA
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Assi, M., Martin, S., Wheat, L. J., Hage, C., Freifeld, A., Avery, R., … Kaul, D. R. (2013). Histoplasmosis after solid organ transplant. Clin Infect Dis, 57(11), 1542–1549. https://doi.org/10.1093/cid/cit593
Assi, Maha, Stanley Martin, L Joseph Wheat, Chadi Hage, Alison Freifeld, Robin Avery, John W. Baddley, et al. “Histoplasmosis after solid organ transplant.Clin Infect Dis 57, no. 11 (December 2013): 1542–49. https://doi.org/10.1093/cid/cit593.
Assi M, Martin S, Wheat LJ, Hage C, Freifeld A, Avery R, et al. Histoplasmosis after solid organ transplant. Clin Infect Dis. 2013 Dec;57(11):1542–9.
Assi, Maha, et al. “Histoplasmosis after solid organ transplant.Clin Infect Dis, vol. 57, no. 11, Dec. 2013, pp. 1542–49. Pubmed, doi:10.1093/cid/cit593.
Assi M, Martin S, Wheat LJ, Hage C, Freifeld A, Avery R, Baddley JW, Vergidis P, Miller R, Andes D, Young J-AH, Hammoud K, Huprikar S, McKinsey D, Myint T, Garcia-Diaz J, Esguerra E, Kwak EJ, Morris M, Mullane KM, Prakash V, Burdette SD, Sandid M, Dickter J, Ostrander D, Antoun SA, Kaul DR. Histoplasmosis after solid organ transplant. Clin Infect Dis. 2013 Dec;57(11):1542–1549.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

December 2013

Volume

57

Issue

11

Start / End Page

1542 / 1549

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Risk Factors
  • Retrospective Studies
  • Organ Transplantation
  • Middle Aged
  • Microbiology
  • Male
  • Immunocompromised Host