{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T13:31:22Z","timestamp":1779197482375,"version":"3.51.4"},"reference-count":58,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T00:00:00Z","timestamp":1682467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Coccidioidomycosis is a fungal infection endemic in the southwestern United States, Mexico, and parts of Central and South America. While coccidioidomycosis is associated with mostly mild infections in the general population, it can lead to devastating infections in immunocompromised patients, including solid organ transplant (SOT) recipients. Early and accurate diagnosis is important in achieving better clinical outcomes in immunocompromised patients. However, the diagnosis of coccidioidomycosis in SOT recipients can be challenging due to the limitations of diagnostic methods including cultures, serology, and other tests in providing a timely and accurate diagnosis. In this review, we will discuss the available diagnostic modalities and approaches when evaluating SOT recipients with coccidioidomycosis, from the use of conventional culture methods to serologic and molecular testing. Additionally, we will discuss the role of early diagnosis in assisting with the administration of effective antifungal therapy to reduce infectious complications. Finally, we will discuss ways to improve the performance of coccidioidomycosis diagnostic methods in SOT recipients with an option for a combined testing approach.<\/jats:p>","DOI":"10.3390\/jof9050513","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T04:42:54Z","timestamp":1682484174000},"page":"513","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Diagnostic Approach to Coccidioidomycosis in Solid Organ Transplant Recipients"],"prefix":"10.3390","volume":"9","author":[{"given":"Tirdad T.","family":"Zangeneh","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, College of Medicine, University of Arizona, 1501 N Campbell Avenue, P.O. Box 245022, Tucson, AZ 85724, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohanad M.","family":"Al-Obaidi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, College of Medicine, University of Arizona, 1501 N Campbell Avenue, P.O. Box 245022, Tucson, AZ 85724, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1029\/2019GH000209","article-title":"Expansion of Coccidioidomycosis Endemic Regions in the United States in Response to Climate Change","volume":"3","author":"Gorris","year":"2019","journal-title":"Geohealth"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2517","DOI":"10.1111\/ajt.15324","article-title":"De novo coccidioidomycosis among solid organ transplant recipients 1 or more years after transplant","volume":"19","author":"Asbury","year":"2019","journal-title":"Am. J. Transplant."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/tid.12372","article-title":"Diagnosis, treatment, and outcomes of coccidioidomycosis in allogeneic stem cell transplantation","volume":"17","author":"Mendoza","year":"2015","journal-title":"Transpl. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1086\/323463","article-title":"Coccidioidomycosis in solid organ transplantation","volume":"33","author":"Blair","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1002\/lt.20654","article-title":"Coccidioidomycosis in liver transplantation","volume":"12","author":"Blair","year":"2006","journal-title":"Liver Transpl."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1034\/j.1399-3062.2003.00005.x","article-title":"Early results of targeted prophylaxis for coccidioidomycosis in patients undergoing orthotopic liver transplantation within an endemic area","volume":"5","author":"Blair","year":"2003","journal-title":"Transpl. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1111\/j.1600-6143.2005.01169.x","article-title":"Coccidioidomycosis after renal transplantation in an endemic area","volume":"6","author":"Braddy","year":"2006","journal-title":"Am. J. Transplant."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1587","DOI":"10.1093\/cid\/ciaa739","article-title":"Clinician Practice Patterns That Result in the Diagnosis of Coccidioidomycosis Before or During Hospitalization","volume":"73","author":"Pu","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/j.1600-6143.2010.03328.x","article-title":"Coccidioidomycosis in liver transplant recipients in an endemic area","volume":"11","author":"Vucicevic","year":"2011","journal-title":"Am. J. Transplant."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s12281-023-00449-1","article-title":"Diagnostic Challenges of Coccidioidomycosis in Solid Organ and Hematopoietic Stem Cell Transplant Recipients","volume":"17","author":"Zangeneh","year":"2023","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1111\/ajt.12144","article-title":"The utility of diagnostic testing for active coccidioidomycosis in solid organ transplant recipients","volume":"13","author":"Mendoza","year":"2013","journal-title":"Am. J. Transplant."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s11046-006-0062-5","article-title":"Serologic testing for symptomatic coccidioidomycosis in immunocompetent and immunosuppressed hosts","volume":"162","author":"Blair","year":"2006","journal-title":"Mycopathologia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3562","DOI":"10.1111\/ajt.13950","article-title":"Coccidioidomycosis Transmission Through Organ Transplantation: A Report of the OPTN Ad Hoc Disease Transmission Advisory Committee","volume":"16","author":"Kusne","year":"2016","journal-title":"Am. J. Transpl."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1111\/j.1399-3062.2011.00696.x","article-title":"Donor-derived organ transplant transmission of coccidioidomycosis","volume":"14","author":"Dierberg","year":"2012","journal-title":"Transpl. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e13365","DOI":"10.1111\/tid.13365","article-title":"Simultaneous coccidioidomycosis and phaeohyphomycosis in a kidney transplant recipient: A case report and literature review","volume":"22","author":"Puing","year":"2020","journal-title":"Transpl. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e234113","DOI":"10.1136\/bcr-2019-234113","article-title":"Opportunistic coinfection with Pneumocystis jirovecii and Coccidioides immitis associated with idelalisib treatment in a patient with chronic lymphocytic leukaemia","volume":"13","author":"Ward","year":"2020","journal-title":"BMJ Case Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"958","DOI":"10.3201\/eid1206.060028","article-title":"Coccidioidomycosis as a common cause of community-acquired pneumonia","volume":"12","author":"Valdivia","year":"2006","journal-title":"Emerg. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"619","DOI":"10.3201\/eid2603.190798","article-title":"Coccidioidomycosis Skin Testing in a Commercially Insured Population, United States, 2014\u20132017","volume":"26","author":"Benedict","year":"2020","journal-title":"Emerg. Infect. Dis."},{"key":"ref_19","first-page":"e159491","article-title":"Immunogenetics associated with severe coccidioidomycosis","volume":"7","author":"Hsu","year":"2022","journal-title":"J. Clin. Investig."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1196\/annals.1406.049","article-title":"Laboratory aspects in the diagnosis of coccidioidomycosis","volume":"1111","author":"Saubolle","year":"2007","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/0732-8893(94)90070-1","article-title":"Bronchoscopic diagnosis of pulmonary coccidioidomycosis. Comparison of cytology, culture, and transbronchial biopsy","volume":"18","author":"DiTomasso","year":"1994","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_22","first-page":"233","article-title":"Primary cutaneous coccidioidomycosis; the criteria for diagnosis and a report of a case","volume":"79","author":"Wilson","year":"1953","journal-title":"Calif. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/0732-8893(92)90103-Z","article-title":"Acquisition of coccidioidomycosis at necropsy by inhalation of coccidioidal endospores","volume":"15","author":"Kohn","year":"1992","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1196\/annals.1406.005","article-title":"Diagnosis of coccidioidomycosis by culture: Safety considerations, traditional methods, and susceptibility testing","volume":"1111","author":"Sutton","year":"2007","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1128\/jcm.32.4.867-870.1994","article-title":"Comparative evaluation of chemiluminescent DNA probe assays and exoantigen tests for rapid identification of Blastomyces dermatitidis and Coccidioides immitis","volume":"32","author":"Padhye","year":"1994","journal-title":"J. Clin. Microbiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1128\/JCM.02847-14","article-title":"Matrix-assisted laser desorption ionization-time of flight mass spectrometry for differentiation of the dimorphic fungal species Paracoccidioides brasiliensis and Paracoccidioides lutzii","volume":"53","author":"Almeida","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2","DOI":"10.3410\/M2-2","article-title":"The diagnosis of coccidioidomycosis","volume":"2","author":"Ampel","year":"2010","journal-title":"F1000 Med. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1128\/JCM.01843-09","article-title":"False-Positive IgM Serology in Coccidioidomycosis","volume":"48","author":"Kuberski","year":"2010","journal-title":"J. Clin. Microbiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e2746","DOI":"10.1093\/cid\/ciaa1205","article-title":"Comparison of a Novel Rapid Lateral Flow Assay to Enzyme Immunoassay Results for Early Diagnosis of Coccidioidomycosis","volume":"73","author":"Donovan","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e112","DOI":"10.1093\/cid\/ciw360","article-title":"2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis","volume":"63","author":"Galgiani","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1128\/CMR.3.3.247","article-title":"Serology of coccidioidomycosis","volume":"3","author":"Pappagianis","year":"1990","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3060","DOI":"10.1128\/JCM.00631-12","article-title":"Serum (1->3)-beta-D-glucan measurement in coccidioidomycosis","volume":"50","author":"Thompson","year":"2012","journal-title":"J. Clin. Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Al-Obaidi, M.M., Ayazi, P., Shi, A., Campanella, M., Connick, E., and Zangeneh, T.T. (2022). The Utility of (1\u21923)-\u03b2-D-Glucan Testing in the Diagnosis of Coccidioidomycosis in Hospitalized Immunocompromised Patients. J. Fungi, 8.","DOI":"10.3390\/jof8080768"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1093\/cid\/ciaa188","article-title":"Advances in Diagnosis of Progressive Pulmonary and Disseminated Coccidioidomycosis","volume":"72","author":"Kassis","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1086\/592073","article-title":"Diagnosis of coccidioidomycosis with use of the Coccidioides antigen enzyme immunoassay","volume":"47","author":"Durkin","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1093\/mmy\/myy111","article-title":"The utility of real-time polymerase chain reaction in detecting Coccidioides immitis among clinical specimens in the Central California San Joaquin Valley","volume":"57","author":"Dizon","year":"2019","journal-title":"Med. Mycol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s11046-010-9327-0","article-title":"The utility of coccidioides polymerase chain reaction testing in the clinical setting","volume":"170","author":"Vucicevic","year":"2010","journal-title":"Mycopathologia"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e01277-17","DOI":"10.1128\/JCM.01277-17","article-title":"Multicenter Clinical Validation of a Cartridge-Based Real-Time PCR System for Detection of Coccidioides spp. in Lower Respiratory Specimens","volume":"56","author":"Saubolle","year":"2018","journal-title":"J. Clin. Microbiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1093\/mmy\/myz125","article-title":"Comparison of three anti-coccidioides antibody enzyme immunoassay kits for the diagnosis of coccidioidomycosis","volume":"58","author":"Malo","year":"2020","journal-title":"Med. Mycol."},{"key":"ref_40","first-page":"2993","article-title":"The Fungal Cell Wall: Candida, Cryptococcus, and Aspergillus Species","volume":"10","author":"Rivera","year":"2019","journal-title":"Front. Microbiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1093\/cid\/civ585","article-title":"Role of Coccidioides Antigen Testing in the Cerebrospinal Fluid for the Diagnosis of Coccidioidal Meningitis","volume":"61","author":"Kassis","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S0140-6736(95)91152-9","article-title":"Plasma (1-->3)-beta-D-glucan measurement in diagnosis of invasive deep mycosis and fungal febrile episodes","volume":"345","author":"Obayashi","year":"1995","journal-title":"Lancet"},{"key":"ref_43","first-page":"CD009833","article-title":"(1\u21923)-\u03b2-D-glucan testing for the detection of invasive fungal infections in immunocompromised or critically ill people","volume":"7","author":"White","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1093\/mmy\/myu077","article-title":"Positive (1-3) B-d-glucan and cross reactivity of fungal assays in coccidioidomycosis","volume":"53","author":"Zangeneh","year":"2015","journal-title":"Med. Mycol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2707","DOI":"10.1128\/JCM.01224-16","article-title":"Cerebrospinal Fluid (1,3)-Beta-d-Glucan Testing Is Useful in Diagnosis of Coccidioidal Meningitis","volume":"54","author":"Stevens","year":"2016","journal-title":"J. Clin. Microbiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1093\/cid\/ciab1028","article-title":"High False-Positive Rate of (1,3)-\u03b2-D-Glucan in Onco-Hematological Patients Receiving Immunoglobulins and Therapeutic Antibodies","volume":"75","author":"Tschopp","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3450","DOI":"10.1128\/AAC.00658-06","article-title":"Reactivity of (1-->3)-beta-d-glucan assay with commonly used intravenous antimicrobials","volume":"50","author":"Marty","year":"2006","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Mao, Y., Li, X., Lou, H., Shang, X., Mai, Y., Yang, L., Peng, F., and Fu, X. (2021). Detection of Coccidioides posadasii in a patient with meningitis using metagenomic next-generation sequencing: A case report. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06661-z"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1093\/cid\/civ388","article-title":"The Return of Delayed-Type Hypersensitivity Skin Testing for Coccidioidomycosis","volume":"61","author":"Wack","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s11046-012-9555-6","article-title":"A Reformulated spherule-derived coccidioidin (spherusol) to detect delayed-type hypersensitivity in coccidioidomycosis","volume":"174","author":"Johnson","year":"2012","journal-title":"Mycopathologia"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1093\/mmy\/myz099","article-title":"Coccidioides (spherulin) skin testing in patients with pulmonary coccidioidomycosis in an endemic region","volume":"58","author":"Mafi","year":"2020","journal-title":"Med. Mycol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1128\/CDLI.12.6.700-704.2005","article-title":"Preliminary evaluation of whole-blood gamma interferon release for clinical assessment of cellular immunity in patients with active coccidioidomycosis","volume":"12","author":"Ampel","year":"2005","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e00065-18","DOI":"10.1128\/mSphere.00065-18","article-title":"Ex Vivo Cytokine Release, Determined by a Multiplex Cytokine Assay, in Response to Coccidioidal Antigen Stimulation of Whole Blood among Subjects with Recently Diagnosed Primary Pulmonary Coccidioidomycosis","volume":"3","author":"Ampel","year":"2018","journal-title":"Msphere"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1093\/cid\/ciu725","article-title":"A breath fungal secondary metabolite signature to diagnose invasive aspergillosis","volume":"59","author":"Koo","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_55","unstructured":"Bean, H. (2019, January 5). Identifying volatile breathmarkers for a Valley fever breath test. Proceedings of the Coccidioidomycosis Study Group Annual Meeting, Davis, CA, USA."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.1021\/acs.jproteome.9b00100","article-title":"Coccidioidomycosis Detection Using Targeted Plasma and Urine Metabolic Profiling","volume":"18","author":"Jasbi","year":"2019","journal-title":"J. Proteome Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1097\/01.rlu.0000233349.46383.06","article-title":"F-18 FDG PET\/CT imaging of disseminated coccidioidomycosis","volume":"31","author":"Nguyen","year":"2006","journal-title":"Clin. Nucl. Med."},{"key":"ref_58","first-page":"100040","article-title":"Detecting pulmonary Coccidioidomycosis with deep convolutional neural networks","volume":"5","author":"Ott","year":"2021","journal-title":"Mach. Learn. Appl."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/9\/5\/513\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:23:23Z","timestamp":1760124203000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/9\/5\/513"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,26]]},"references-count":58,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["jof9050513"],"URL":"https:\/\/doi.org\/10.3390\/jof9050513","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,26]]}}}