Blair J E, Mulligan D C
Division of Infectious Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA.
Transpl Infect Dis. 2007 Mar;9(1):78-82. doi: 10.1111/j.1399-3062.2006.00179.x.
Coccidioidomycosis is a fungal infection caused by Coccidioides species endemic to the southwestern United States, where it poses unique challenges for transplant recipients. Donor-derived coccidioidomycosis has been documented, but its risk of transmission is not known. We prospectively screened 568 healthy persons requesting evaluation for possible liver or kidney donation. Twelve (2.1%) of the 568 donor candidates were seropositive (11 initially and 1 with seroconversion and symptomatic illness within 1 week after negative screening). Three of these 12 patients proceeded to kidney donation, and a fourth patient proceeded to liver donation. None of the 4 transplant recipients received special coccidioidal prophylaxis, although all were administered fluconazole according to standard antifungal prophylaxis protocols. At follow-up (7-54 months), no coccidioidomycosis was identified in any recipient. The prevalence of coccidioidal antibodies was low among potential organ donor candidates, but the risk of donor-derived coccidioidomycosis remains unknown and further study is warranted.
球孢子菌病是一种由球孢子菌属引起的真菌感染，该菌在美国西南部为地方病，对移植受者构成独特挑战。供体来源的球孢子菌病已有记录，但尚不清楚其传播风险。我们对568名请求评估是否适合进行肝脏或肾脏捐献的健康人进行了前瞻性筛查。568名供体候选人中有12人（2.1%）血清学呈阳性（11人最初即为阳性，1人在筛查阴性后1周内血清转化并出现症状性疾病）。这12名患者中有3人进行了肾脏捐献，第4名患者进行了肝脏捐献。4名移植受者均未接受特殊的球孢子菌预防措施，尽管所有患者均按照标准抗真菌预防方案给予氟康唑治疗。在随访（7 - 54个月）期间，任何受者均未发现球孢子菌病。潜在器官供体候选人中球孢子菌抗体的患病率较低，但供体来源的球孢子菌病风险仍未知，有必要进一步研究。
