Phonphok Korntip, Beaird Omer, Duong Tin, Datta Nakul, Schaenman Joanna, Bunnapradist Suphamai
Department of Medicine, Division of Nephrology, Kidney and Pancreas Transplant Research Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Department of Medicine, Division of Nephrology, Rajavithi Hospital, Bangkok, Thailand.
Transpl Infect Dis. 2018 Oct;20(5):e12932. doi: 10.1111/tid.12932. Epub 2018 Jul 26.
Kidney transplant recipients (KTRs) are at risk for reactivation and complicated infection due to Coccidioides. Pre-transplant serological screening should provide benefit for patients from endemic areas. We evaluated Coccidioides seroprevalence by area of residence in KTRs at a major transplant program in Los Angeles.
We performed cross-sectional analyses of adult KTRs who underwent transplantation at UCLA between 2007-2016. Patients with Coccidioides serology by enzyme immunoassay (EIA) before or within 14 days from transplantation were included. Patients were classified as living in highly, established, suspected, or not endemic areas by their residential zip code.
Overall prevalence of Coccidioides IgG and IgM were 1.4% and 2.8%, respectively. Of patients with positive serology, 31.4% had isolated IgG and 66.3% isolated IgM. Patients from established and highly endemic areas had IgG seropositivity of 3.7% versus 1.3% for patients living in suspected endemic areas(P < .01). Rates of IgM seropositivity were 3.7% compared to 2.8% respectively (P = .28). No patients from non-endemic areas had positive screening serology.
Pre-transplant serological screening for Coccidioides is recommended in kidney transplant candidates from endemic areas. We observed high seroprevalence among patients from highly and established endemic areas, for whom universal prophylaxis is recommended. For residents from less well-established areas of endemicity, serological screening showed benefit in identifying patients at risk. In patients with isolated EIA IgM, performing repeat and confirmatory tests is recommended. Patients from non-endemic areas had low risk of infection, however, a thorough social history is necessary to evaluate risk.
肾移植受者（KTRs）有因球孢子菌而出现再激活和复杂感染的风险。移植前的血清学筛查应对来自流行地区的患者有益。我们在洛杉矶的一个主要移植项目中，根据居住地区评估了KTRs中球孢子菌的血清阳性率。
我们对2007年至2016年在加州大学洛杉矶分校接受移植的成年KTRs进行了横断面分析。纳入在移植前或移植后14天内通过酶免疫测定（EIA）进行球孢子菌血清学检测的患者。根据患者居住的邮政编码，将其分类为生活在高度流行、已确定流行、疑似流行或非流行地区。
球孢子菌IgG和IgM的总体阳性率分别为1.4%和2.8%。血清学阳性的患者中，31.4%为单纯IgG阳性，66.3%为单纯IgM阳性。来自已确定流行和高度流行地区的患者IgG血清阳性率为3.7%，而生活在疑似流行地区的患者为1.3%（P <.01）。IgM血清阳性率分别为3.7%和2.8%（P =.28）。非流行地区的患者筛查血清学均为阴性。
建议对来自流行地区的肾移植候选者进行移植前球孢子菌血清学筛查。我们观察到来自高度流行和已确定流行地区的患者血清阳性率很高，建议对这些患者进行普遍预防。对于来自流行程度较低地区的居民，血清学筛查有助于识别有风险的患者。对于单纯EIA IgM阳性的患者，建议进行重复和确证试验。非流行地区的患者感染风险较低，然而，有必要全面了解其社会史以评估风险。
