Histoplasmosis in renal allograft recipients. Two large urban outbreaks

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Abstract
During 2 large outbreaks, 10 episodes of histoplasmosis were documented in 8 renal allograft recipients. Another episode occurred before the outbreaks. Associated infections with cytomegalovirus occurred in 5 patients and may have further impaired cellular immunity. Prolonged fever was the predominant clinical finding; and dissemination was observed in 7 of 9 patients, including 3 with meningitis. Special stains of tissues and the histoplasmal complement fixation test provided useful diagnostic information rapidly, while cultures were eventually positive in 7 patients. Treatment with amphotericin B resulted in prompt clinical improvement in all patients, but relapse occurred in 2 patients 1 yr following therapy.