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March 1982

Coccidioidomycosis in Renal Replacement Therapy

Author Affiliations

From the Departments of Medicine, University of Arizona College of Medicine, Tucson, and Tucson (Ariz) Veterans Administration Medical Center (Drs Cohen, Galgiani, and Ogden); and Good Samaritan Hospital of Phoenix (Ariz) (Dr Potter). Dr Cohen is now with Doctor's Hospital, Phoenix, Ariz.

Arch Intern Med. 1982;142(3):489-494. doi:10.1001/archinte.1982.00340160069017

The potential risk of coccidioidomycosis has led to concern about the advisability of maintaining renal transplantation programs in endemic areas. We reviewed the charts of 721 patients undergoing dialysis and 260 renal transplant recipients in Arizona to determine the incidence, risk factors, and clinical course of coccidioidomycosis in these immunosuppressed populations. Symptomatic infection occurred in six (0.8%) patients undergoing dialysis and 18 (6.9%) transplant recipients. Male sex and blood type B predisposed to dissemination. Urine cultures for fungus were important diagnostic aids. Four of six patients with infection limited to the thorax and five of 18 patients with dissemination remained alive after seven months to 7 1/2 years. Although the rate of dissemination (75%) and mortality (63%) from coccidioidomycosis were high, the incidence of infection was low and does not preclude renal transplantation in Arizona. Those who have received transplants elsewhere should be advised not to move to or visit areas endemic for coccidioidomycosis.

(Arch Intern Med 1982;142:489-494)

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