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7% of paediatric kidney transplant recipients develop disseminated histoplasmosis in Tennessee

November 05 2018

Solid organ transplant recipients are at increased risk of disseminated histoplasmosis, and paediatric cases are particularly challenging due to differences in immunity and antifungal pharmacokinetics.

Dr Kenice Ferguson-Paul and colleagues in Memphis (TN, USA) recently published a series of 6 cases of disseminated histoplasmosis among paediatric kidney transplant patients over a 14 year period. Of 87 paediatric kidney transplant patients, 6 (6.9%) were diagnosed with disseminated histoplasmosis. Median time to infection was 14.8 months. In most patients the infection progressed rapidly after admission, yet they all survived. Key issues in the treatment of this cohort of patients included: nephrotoxicity of amphotericin B; drug interactions between antifungals and immunosuppressants; rapid metabolism of antifungals in children. In adult populations, prevalence of disseminated histoplasmosis is lower (0-2%) and time to infection is slightly longer.

Clinicians in endemic regions should test patients presenting with unexplained fever, fatigue and respiratory symptoms, using the histoplasmosis antigen assay (urine, serum, BAL) and/or direct microscopy with GMS stain (BAL). For milder forms of the disease it may be possible to initiate therapy with itraconazole (less nephrotoxic than amphotericin B), although careful monitoring is required to balance azoles and immunosuppressive agents.

Read the full  paper: Ferguson-Paul et al (2018) Disseminated histoplasmosis in pediatric kidney transplant recipients. Pediatr Transplant. e13274