Histoplasmosis in solid organ transplant recipients: Early diagnosis and treatment

Purpose of review: To present current knowledge about the epidemiology, clinical presentation, diagnosis and treatment of histoplasmosis in solid organ transplant (SOT) recipients. Recent findings: Histoplasmosis is rare in SOT patients, and most cases have been reported from large transplant centers in the Midwestern USA, where the fungus is endemic. Urine antigen testing and the chest computed tomography scan are emerging as especially useful diagnostic tools in the SOT population. Standard treatments include liposomal amphotericin b followed by itraconazole, but newer azoles (voriconazole and posaconazole) have good in-vitro activity and have been successfully used in some SOT cases. Summary: Clinical suspicion is essential to early recognition of histoplasmosis in SOT patients who often present with fever of unknown cause and pulmonary symptoms. Diagnosis is usually made by a combinatorial approach, including antigen tests, radiology and appropriate biopsies for culture and histology. Treatment with available antifungals is associated with more than 95% success.