The clinical spectrum of coccidioidomycosis has been influenced significantly by the increasing number of patients with T-cell deficiencies such as those that occur with organ transplantation, corticosteroid therapy, and AIDS. In such patients, infection is much more likely to be extensive. For example, of renal transplant recipients who developed coccidioidal illness, approximately three-quarters manifested extrapulmonary lesions. Another difference for the immunosuppressed is a substantial risk of recrudescence after prior infection. In five renal transplant recipients with documented coccidioidal infections prior to engraftment, three developed recurrent infection after beginning immunosuppression. This risk is relevant to organ transplantation centers worldwide and is one of the reasons that coccidioidomycosis can no longer be considered a regional problem. Standard serologic tests for coccidioidomycosis are usually helpful to identify most forms of active coccidioidal infection. Reticulonodular pneumonia is an exception, and as many as one-third of such patients may fail to demonstrate antibodies. If diagnosed promptly, coccidioidomycosis in immunosuppressed patients often responds favorably to treatment with either amphotericin B or oral triazoles. Oral prophylaxis may be appropriate for selected patients undergoing transplantation, and a registry would be useful to further define the optimal strategy for these patients.
Full conference title:
Coccidioidomycosis - Centennial Conference