Coccidioidomycosis_T

This is likely to have been a donor-derived infection, with two recipients from a non-endemic area becoming infected with a geographically restricted agent which was isolated from donor BAL; however, the paper does not provide sufficient information to establish such level imputability, which is inferred. The donor chest-x-ray showed a 12 mm calcified lung mass which was not removed (felt to represent a possible past infectious process), with pulmonary calcifications less consistent with coccidiodiomycosis. Routine donor graft BAL fungal culture was positive on day +7 post transplant but the identification of Coccidioides spp was only made on post transplant day+47 by PCR. While the right liver lobe and lung transplant recipients developed active coccidiodiomycosis infection, the heart and bilateral kidney recipients did not receive prophylaxis and had no evidence of symptomatic infection. No serology of donor and recipients (pre and post-transplant) is mentioned in the paper. The authors do not describe detailed epidemiology and medical history for the donor and recipients, apart from mentioning that the donor had travelled to South America 4 months before death and that he had been coughing; the young left liver lobe recipient was said to have been born and lived in France; the other 5 recipients were adults and it is not mentioned whether or not they might have lived or travelled to an endemic area. Although molecular techniques were used to detect and or identify the Coccidioides strains, no molecular epidemiology work was carried out to analyse strain relatedness.