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Donor-Derived Coccidioides immitis Endocarditis and Disseminated Infection in the Setting of Solid Organ Transplantation.

Nelson JK, Giraldeau G, Montoya JG, Deresinski S, Ho DY, Pham M - Open Forum Infect Dis (2016)

Bottom Line: Results.  Fifteen prior cases of donor-derived coccidioidomycosis were identified.A majority of these cases were diagnosed by positive culture (83%).Mortality was high at 58%.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases and Geographic Medicine.

ABSTRACT
Background.  Endocarditis is a rare manifestation of infection with Coccidioides. This is the first reported case of donor-derived Coccidioides endocarditis obtained from a heart transplant. Methods.  We present a unique case of donor-derived Coccidioides immitis endocarditis and disseminated infection in a heart transplant patient. We also conducted a review of the literature to identify other cases of donor-derived coccidioidomycosis in solid organ transplant recipients and reviewed their clinical characteristics. Results.  Fifteen prior cases of donor-derived coccidioidomycosis were identified. A majority of these cases were diagnosed by positive culture (83%). Mortality was high at 58%. Conclusions.  Clinicians should maintain a high index of suspicion for disseminated coccidioidomycosis in patients who received transplants with organs from donors with a history of residing in endemic regions.

No MeSH data available.


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Grocott's methenamine silver stain of donor lung tissue showing arthroconidia.
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OFW086F3: Grocott's methenamine silver stain of donor lung tissue showing arthroconidia.

Mentions: Post mortem, the patient's pretransplant serum was obtained and testing for Coccidioides by immunodiffusion and compliment fixation was negative. Further investigation on the donor after our patient's death revealed that the donor serum was positive for Coccidioides by immunodiffusion but had a negative complement fixation titer, most consistent with localized disease. The donor's lung pathology was reviewed and showed arthroconidia in deep tissue block samples consistent with fungal disease, likely coccidioidomycosis in this clinical context (Figure 3). The original pathology review was not performed at our institution so it is difficult to speculate why the diagnosis was not made initially. In retrospect, it is possible that knowing the diagnosis allowed pathologists to locate arthroconidia that were seen deep in the tissue block.Figure 3.


Donor-Derived Coccidioides immitis Endocarditis and Disseminated Infection in the Setting of Solid Organ Transplantation.

Nelson JK, Giraldeau G, Montoya JG, Deresinski S, Ho DY, Pham M - Open Forum Infect Dis (2016)

Grocott's methenamine silver stain of donor lung tissue showing arthroconidia.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940450&req=5

OFW086F3: Grocott's methenamine silver stain of donor lung tissue showing arthroconidia.
Mentions: Post mortem, the patient's pretransplant serum was obtained and testing for Coccidioides by immunodiffusion and compliment fixation was negative. Further investigation on the donor after our patient's death revealed that the donor serum was positive for Coccidioides by immunodiffusion but had a negative complement fixation titer, most consistent with localized disease. The donor's lung pathology was reviewed and showed arthroconidia in deep tissue block samples consistent with fungal disease, likely coccidioidomycosis in this clinical context (Figure 3). The original pathology review was not performed at our institution so it is difficult to speculate why the diagnosis was not made initially. In retrospect, it is possible that knowing the diagnosis allowed pathologists to locate arthroconidia that were seen deep in the tissue block.Figure 3.

Bottom Line: Results.  Fifteen prior cases of donor-derived coccidioidomycosis were identified.A majority of these cases were diagnosed by positive culture (83%).Mortality was high at 58%.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases and Geographic Medicine.

ABSTRACT
Background.  Endocarditis is a rare manifestation of infection with Coccidioides. This is the first reported case of donor-derived Coccidioides endocarditis obtained from a heart transplant. Methods.  We present a unique case of donor-derived Coccidioides immitis endocarditis and disseminated infection in a heart transplant patient. We also conducted a review of the literature to identify other cases of donor-derived coccidioidomycosis in solid organ transplant recipients and reviewed their clinical characteristics. Results.  Fifteen prior cases of donor-derived coccidioidomycosis were identified. A majority of these cases were diagnosed by positive culture (83%). Mortality was high at 58%. Conclusions.  Clinicians should maintain a high index of suspicion for disseminated coccidioidomycosis in patients who received transplants with organs from donors with a history of residing in endemic regions.

No MeSH data available.


Related in: MedlinePlus