Coccidioides immitis

Record number: 
Adverse Occurrence type: 
MPHO Type: 
Time to detection: 
0 days
Alerting signals, symptoms, evidence of occurrence: 
64 yr old man in North Carolina, USA (not endemic for C immitis) died of disseminated coccidioidomycosis and candidiasis one month after bilateral lung transplant for COPD. He was poorly responsive after surgery, with coagulopathy, hypotension, and progressive hypoxia and progressive lung inflitration and opacity. At 2 weeks cultures of blood and CSF were negative. Multiorgan failure developed. At 3 weeks a brain MRI was compatible with multifocal fungal infection. Blood culture grew Candida parapsilosis. Bronchial washing showed Candida, Coccidiomycosis immitis, S. maltophilia. He died at one month.
Demonstration of imputability or root cause: 
Level 2. Possible. Disseminated coccidiomycosis shortly after lung transplant. Both donor and recipient resided in non-endemic area. Autopsy showed disseminated C immitis in lung and spleen, fungal pericarditis and nephritis. The donor had traveled to Mexico 2 years earlier. Recipient had no travel history to an area where Coccidioides immitis is endemic. The authors concluded the patient's death was largely related to acute Coccidiomycosis immitis infection carried by the donor lungs. Generally coccidioidomycosis after organ transplantation occurs at 4-6 month postop and is a reactivation of the recipient's latent infection.
Imputability grade: 
1 Possible
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