Incidence and prevalence of coccidioidomycosis in patients with end-stage liver disease

Coccidioidomycosis is an endemic fungal infection of the desert southwestern United States. Patients with endstage liver disease (ESLD) have not been described as having a high rate of coccidioidal infection. We prospectively evaluated 290 patients with ESLD for liver transplantation and found that 6 of these patients (2.1%) had active coccidioidal infection at presentation. Of 184 patients listed for transplantation, 48 patients were observed for at least 1 year; among these 48 patients, new coccidioidal infection developed in 2 patients within the year, for a 1-year incidence of 4.2%. Conversely, the incidence of coccidioidal infection in Maricopa County, Arizona in that same period was 0.04%. Awareness is needed to identify the presence of coccidioidal infection, which may be masked by symptoms and findings of ESLD. Treatment may alleviate some of the symptoms of coccidioidomycosis originally attributed to the concomitant liver disease.