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Symptomatic disease occurs in both the immunocompetent and immunocompromised host with the severity of infection correlating with underlying immune status. Cell mediated immunity plays an important role in the susceptibility to and control of these infections. Recently reports of endemic fungal infections occurring in organ transplant recipients have been increasing [1, 2]. In addition, increased recognition of donor-derived fungal infections in recipients prompted the recent development of guidelines discussing the unique characteristics, evaluation and approach to their http://www.selleckchem.com/products/CP-690550.html management [3]. Although the true incidence of these infections among this population is unknown, estimates suggest it is http://www.selleck.cn/products/MLN8237.html New York and Canadian provinces that border the Great Lakes and St. Lawrence Seaway. Recent studies have shown an increase in the incidence of blastomycosis in some of these endemic regions [6, 9, 10]. The majority of reported cases http://www.selleckchem.com/products/XL184.html of blastomycosis after organ transplantation have occurred in patients residing in endemic areas [1, 11]. Historically blastomycosis has been a disease that affects immunocompetent hosts, predominantly men with outdoor occupations or recreational activities involving soil exposure, although many individuals have no apparent source for infection [8, 12]. In the immunocompromised host, it may be associated with severe pneumonia or disseminated infection, particularly in patients with diabetes, HIV or those receiving chronic corticosteroids or cytotoxic chemotherapy [13]. Unlike coccidioidomycosis or histoplasmosis, blastomycosis has been described infrequently as an opportunistic pathogen after solid organ transplantation [1, 6, 11]. In one review, the cumulative incidence posttransplant was only 0.14% during a 16-year period [1]. Reports of blastomycosis after renal, cardiac, hepatic and lung transplantation have been published with disease onset ranging from 1?week to 20 years posttransplant [1, 6, 11, 13, 14]. Blastomycosis in this population may result from primary infection, reactivation of latent disease or conversion of subclinical infection to symptomatic disease after organ transplantation [1].