Background: Solid organ transplant (SOT) recipients residing in a Coccidioides-endemic region that acquire infection are at risk for complicated and protracted infection. Following transplantation, prophylaxis for 6 to 12 months is recommended in patients without a history of coccidioidomycosis living in an endemic area. To date, there are no studies that describe coccidioidal infection, treatment, and outcomes in SOT patients after post-transplant year 1, and after discontinuation of azole prophylaxis. We aimed to describe the presentation, treatment, and outcome of coccidioidomycosis in SOT recipients at least one year after transplantation and following discontinuation of prophylaxis.

Methods: This study was a joint project of the University of Arizona (UA) and Mayo Clinic Arizona. We conducted an electronic search of all patients with a history of SOT from 11/01/1998 through 12/31/2015, and combined that list with a list of all patients who tested positive in the same time frame. This abstract summarizes the work done at the UA. We retrospectively reviewed the patients with no prior coccidioidomycosis, who developed disease one year post-transplantation and after discontinuation of prophylaxis.

Results: We identified 41/1693 patients with de novo coccidioidomycosis after 1 year post-transplant. Presentations included asymptomatic seropositive (n=24/41, 58.5%), pulmonary (n=12/41, 29.3%) and disseminated disease (n=3/41, 7.3%). 75% of patients with pulmonary infection were symptomatic. The 3 patients with disseminated disease were symptomatic. More symptomatic patients (47.1%) were hospitalized than asymptomatic (4.2%).10/24 (41.7%) of asymptomatic patients were not treated, without sequela, and 76.5% of symptomatic patients were treated, and 1 patient died from coccidioidomycosis.

Conclusions: Whereas coccidioidomycosis in newly transplanted patients on high level immunosuppression can be manifested by severe or disseminated disease, many of the recipients with newly-developed coccidioidomycosis after post-transplant year 1 were asymptomatic. However, severe, disseminated, and fatal infections still occurred, mandating the need for continued vigilance and targeted antifungal prophylaxis.

CITATION INFORMATION: Zangeneh T., August J., Beatty N., Asbury K., Mi L., Blair J. A Retrospective Review of De Novo Coccidioidomycosis among Remote Solid Organ Transplant Recipients in Arizona Am J Transplant. 2017;17 (suppl 3).

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