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Histoplasmosis and Blastomycosis in Solid Organ Transplant Recipients

1
Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, University of Michigan Medical School, Ann Arbor, MI 48105, USA
2
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Shmuel Shoham
J. Fungi 2015, 1(2), 94-106; https://doi.org/10.3390/jof1020094
Received: 29 May 2015 / Revised: 17 June 2015 / Accepted: 18 June 2015 / Published: 30 June 2015
(This article belongs to the Special Issue Fungal Infections in Transplant Recipients)
Histoplasmosis and blastomycosis are geographically restricted dimorphic fungi that cause infection after the conidia produced in the mold phase are inhaled into the lungs. In the lungs, at 37 °C, these organisms undergo transformation into the yeast phase. In transplant recipients, infection can occur by exposure to the mold in the environment, by reactivation of infection that had occurred previously and had been controlled by the host until immunosuppressive medications were given post-transplantation, and finally by transmission from the donor organ in the case of histoplasmosis. In transplant recipients, disseminated infection is common, and pulmonary infection is more likely to be severe than in a non-immunosuppressed person. Diagnosis has been improved, allowing earlier treatment, with the use of rapid antigen tests performed on serum and urine. Initial treatment, for all but the mildest cases of acute pulmonary histoplasmosis, should be with a lipid formulation of amphotericin B. After clinical improvement has occurred, step-down therapy with itraconazole is recommended for a total of 12 months for most transplant recipients, but some patients will require long-term suppressive therapy to prevent relapse of disease. View Full-Text
Keywords: histoplasmosis; blastomycosis; endemic mycoses; solid organ transplantation; liposomal amphotericin B; azoles histoplasmosis; blastomycosis; endemic mycoses; solid organ transplantation; liposomal amphotericin B; azoles
MDPI and ACS Style

Kauffman, C.A.; Miceli, M.H. Histoplasmosis and Blastomycosis in Solid Organ Transplant Recipients. J. Fungi 2015, 1, 94-106.

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