Jose F Camargo

University of Miami Miller School of Medicine | UM · Division of Infectious Diseases

Introduction: Cytomegalovirus (CMV) reactivation is a major complication among seropositive allogeneic hematopoietic cell transplantation (HCT) recipients; however, the incidence and outcomes of CMV reactivation in patients undergoing chimeric antigen receptor T (CAR T) cell therapy remain poorly understood. Methods: Single-center retrospective stu...

Background Isavuconazole (ISA) is a newer antifungal used in patients with history of hematologic malignancies and hematopoietic transplant and cellular therapies (HM/TCT). Although it has a more favorable side‐effect profile, breakthrough invasive fungal infections (bIFIs) while on ISA have been reported. Methods In this single‐center retrospecti...

Background: The optimal number of doses as well as the role for measurement of postvaccination titers after measles, mumps, rubella (MMR) vaccination in adult hematopoietic cell transplantation (HCT) recipients remains unknown. Methods: In the present study, we assessed humoral immunity against measles, mumps and rubella before and after MMR vac...

We report a case of an immunocompromised man with monkeypox who experienced disease progression despite timely initiation of tecovirimat and ultimately required utilization of cidofovir and VIGIV for treatment. In immunocompromised patients, monkeypox might present with a more severe course of disease requiring consideration of alternative treatmen...

Background: Data on severe acute respiratory distress syndrome coronavirus 2 monoclonal antibody (SARS-CoV-2-specific mAb) use in hematologic malignancy and hematopoietic cell transplantation (HM/HCT) patients are limited. Here, we describe our experience with the use of casirivimab-imdevimab or bamlanivimab for the treatment of coronavirus diseas...

Background Respiratory virus infections (RVI) are an important cause of pneumonia with increased risk of morbidity and mortality in patients with hematologic malignancies (HM) especially after stem cell transplantation. However, data on RVI in this population without stem cell transplant is still lacking. Here we aim to look at trends of RVI in HM...

Background Mycobacterium abscessus is increasingly recognised as a human pathogen causing life-threatening infections in immunocompromised patients. There is paucity of data around this topic in solid organ transplant (SOT) recipients. Methods Single center retrospective cohort study of all SOT recipients with a positive culture for M. abscessus b...

Invasive aspergillosis is the most common invasive mold infection following a hematopoietic cell transplant. Widespread use of antifungal prophylaxis has led to increasing incidence of cryptic Aspergillus species. Aspergillus calidoustus is one of those emerging species and is notorious for multidrug resistance to antifungals. Here we report a case...

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been raging since the end of 2019 and has shown worse outcomes in solid organ transplant recipients (SOTR). The clinical differences as well as outcomes between these respiratory viruses have not been well defined in SOTR. Methods This is a retrospective cohort st...

To the Editor— We read with interest the recent trial by Pujol et al pertaining to combination daptomycin with intravenous fosfomycin in methicillin-resistant Staphylococcus aureus bacteremia [1]. In comparison to patients receiving daptomycin alone, combination therapy produced a trend toward higher cure rates at end of therapy and rapid bacteremi...

Background : Adenovirus (AdV) is a serious infection following hematopoietic cell transplantation (HCT). Little is known about AdV viral kinetics and optimal threshold for initiation of pre-emptive therapy. Methods : Single-center retrospective study of 16 consecutive adult HCT recipients with detectable AdV identified over a five-year period. Re...

Background: The use of haploidentical or HLA mismatched unrelated donors (MMUD) allows allogeneic hematopoietic cell transplantation (HCT) in individuals without suitable matched donors. Post-transplant cyclophosphamide (PTCy) is used routinely for prevention of graft-versus-host disease (GVHD) in recipients of haploidentical transplants and its u...

Problem The utility of the PCR cycle threshold (Ct) values in the management of patients with COVID-19 remains controversial. Methods We assessed the correlation of SARS-CoV-2 Ct values in nasopharyngeal swab samples with oxygen requirements at the time of sample collection. Specimens were tested with the Simplexa® PCR platform, which targets the...

Background: One year into the pandemic, published data on hematopoietic cell transplantation (HCT) recipients with COVID-19 remains limited. Methods: Single-center retrospective cohort study of adult HCT recipients with PCR-confirmed SARS-CoV-2 infection. Results: Twenty-eight consecutive transplantation & cellular therapy patients (autologous...

Severe acute respiratory virus syndrome 2 (SARS-CoV-2) has led to a worldwide pandemic. Early studies in solid organ transplant (SOT) recipients suggested a wide variety of presentations, however, there remains a paucity of robust data in this population. We conducted a systematic review and meta-analysis of SOT recipients with SARS-CoV-2 infection...

Background Community acquired respiratory virus infections (RVI) are a major concern in solid organ transplant (SOT) recipients due to severe complications such as lower respiratory tract infection (LRTI), superimposed fungal and bacterial pneumonia, intensive care admission and mortality. Besides influenza and respiratory syncytial virus (RSV), th...

Key Points Shingrix is poorly immunogenic following allogeneic hematopoietic cell transplantation independent of age, CD4, and B-cell recovery. In hematopoietic cell transplantation recipients with antibody response to the vaccine, varicella zoster virus reactivation risk is not null.

Background Coronavirus 2019 (COVID‐19) pandemic has resulted in more than 350,000 deaths worldwide. The number of kidney transplants has declined during the pandemic. We describe our deceased donor kidney transplantation (DDKT) experience during the pandemic. Methods A retrospective study was conducted to evaluate the safety of DDKT during the COV...

Purpose The burden of urinary tract infections (UTIs) and risk factors for developing infections with multidrug resistant organisms (MDROs) post kidney transplantation (KT) are poorly understood. Methods Single‐center retrospective cohort study (January 2015‐December 2017) evaluating first and recurrent episodes of bacteriuria and subsequent analy...

Invasive sino-orbital aspergillosis is an uncommon but potentially life-threating complication of kidney transplantation. Here we report a case of a patient with invasive aspergillus fumigatus sinusitis extending into the orbit in a kidney transplant recipient who was successfully treated with voriconazole and surgical debridement without requiring...

Invasive aspergillosis (IA) is the most common invasive fungal infection following a hematopoietic cell transplant, with emerging cryptic species exhibiting resistance to commonly used antifungals such as azoles. These species have been increasingly found after the introduction of anti-mold prophylaxis. We report a case of a 56-year-old female with...

Progressive multifocal leukoencephalopathy (PML) remains a life-threatening central nervous system infection in immunocompromised patients. Although outcomes have improved in cases that immune reconstitution is feasible with anti-retroviral therapy (ART) in HIV + patients or natalizumab removal in those with multiple sclerosis, in individuals with...

Background Hematopoietic cell transplant (HCT) recipients are at high risk for Varicella zoster virus (VZV) reactivation. Shingrix, the adjuvanted recombinant zoster vaccine, is a new alternative to the live-attenuated VZV vaccine for immunocompromised individuals. Post-marketing data on its immunogenicity and safety in HCT is limited. Objectives...

Introduction Toxoplasma gondii DNA can be detected by polymerase chain reaction (PCR) in up to 16% of hematopoietic cell transplant (HCT) patients post-transplant with attributable mortality of 44-66%. The majority (73-87%) of cases result from reactivation in previously exposed (i.e., Toxoplasma seropositive) recipients and most (67-87%) occur in...

Introduction After allogeneic stem cell transplant (SCT), varicella zoster virus (VZV) necessitates long term chemoprophylaxis due to limitations of the live vaccine. The recombinant subunit vaccine containing VZV glycoprotein E with AS01B adjuvant system (HZ/su, or Shingrix) has safety and efficacy data after autologous transplantation. However, d...

Adenovirus (AdV) viremia occurs in up to 10% of patients following allogeneic hematopoietic cell transplant (HCT). Although AdV disease can be severe and associated with high mortality among those with pneumonia or disseminated disease, little is known about the viral kinetics of AdV and the natural history of untreated viremia following HCT or CAR...

Introduction Cytomegalovirus (CMV) is the most common opportunistic infection following hematopoietic cell transplantation (HCT). Letermovir was approved in 2017 by the Food and Drug Administration (FDA) for prevention of CMV infection in allogeneic HCT patients. Letermovir was shown to be safe and effective in the phase 3 trial but published post-...

Background: Cell-free DNA (cfDNA) sequencing has emerged as an effective laboratory method for rapid and noninvasive diagnosis in prenatal screening testing, organ transplant rejection screening, and oncology liquid biopsies but clinical experience for use of this technology in diagnostic evaluation of infections in immunocompromised hosts is limit...

Background: Cell-free DNA (cfDNA) sequencing has emerged as an effective laboratory method for rapid and noninvasive diagnosis in prenatal screening testing, organ transplant rejection screening, and oncology liquid biopsies but clinical experience for use of this technology in diagnostic evaluation of infections in immunocompromised hosts is limit...

Background The opportunistic parasite Toxoplasma causes life-threatening complications in immunocompromised hosts such as hematopoietic cell transplantation (HCT) recipients. Trimethoprim-sulfamethoxazole (TMP-SMX) is the agent of choice in preventing Pneumocystis jirovecii pneumonia and Toxoplasma, but bone marrow suppression often precludes its u...

Background The use of haploidentitical or HLA mismatched unrelated donors permits allogeneic hematopoietic cell transplantation (HCT) in individuals with otherwise no donors available. Post-transplantcyclophosphamide(PTCy) is used for prevention graft-vs.-host disease (GVHD) in recipients of mismatched donors. We hypothesized that type and incidenc...

Toxoplasma gondii DNA can be detected in peripheral blood by polymerase chain reaction (PCR) in up to 16% of hematopoietic cell transplant (HCT) patients in the first 6 months post‐transplant; and disease occurs in 3‐6%1‐3, with attributable mortality of 44‐66%4‐6, and about a quarter of cases being diagnosed post‐mortem5. The majority (73‐87%) of...

Background: Cell-free DNA (cfDNA) sequencing has emerged as an effective laboratory method for rapid and noninvasive diagnosis in prenatal screening testing, organ transplant rejection screening, and oncology liquid biopsies. Methods: Here we report our experience using next-generation sequencing (NGS) for detection of microbial cfDNA in a cohort o...

Introduction: HIV-positive (HIV+) kidney transplant recipients exhibit a 2- to 3-fold increased risk of allograft rejection. Dysregulated immune activation in HIV infection persists despite successful antiretroviral therapy and is associated with non-AIDS morbidity, including renal disease. We hypothesized that the pathological levels of inflammat...

Background: Cell-free DNA (cfDNA) sequencing has emerged as an effective laboratory method for rapid and noninvasive diagnosis in prenatal screening testing, organ transplant rejection screening, and oncology liquid biopsies. Methods: Here we report our experience using next-generation sequencing (NGS) for detection of microbial cfDNA in a cohort o...

These updated AST‐IDCOP guidelines provide information on epidemiology, diagnosis, and management of Aspergillus after organ transplantation. Aspergillus is the most common invasive mold infection in solid organ transplant (SOT) recipients, and the most common invasive fungal infection among lung transplant recipients. Time from transplant to diagn...

Background Data on bloodstream infection (BSI) due to enteric organisms is scarce. Methods This retrospective study (1/2009‐5/2017) aimed to evaluate the incidence of BSI episodes due to enteric organisms during the first six months after ITx. Differences between the first (2009‐2012) and second period (2013‐2017) were evaluated as they differed f...

Background Cytomegalovirus (CMV) infection is the most common infection following hematopoietic cell transplantation (HCT). Pre-emptive antiviral therapy is highly effective at halting viral replication and preventing CMV disease; however, recurrence rates after clearance of CMV DNAemia are high (50-70%). Current treatment guidelines recommend main...

Background Cell-free DNA (cfDNA) sequencing has emerged as a novel laboratory method for rapid and noninvasive diagnosis in prenatal screening, organ transplant rejection, and tumor detection. We describe a series of immunocompromised patients in which cfDNA sequencing was applied to infectious disease diagnosis. Methods Ten adult patients receivi...

Background Previous studies have demonstrated inferior patient and graft survival following kidney transplant (KT) in HIV+/HCV+ coinfected patients compared to HIV+/HCV‐ recipients. However, these studies were conducted prior to the availability of direct acting antiviral (DAA) agents and data in the modern era is lacking. Methods Single center re...

Background Strongyloides stercoralis infects 100 million people worldwide. Mortality rates in hyperinfection syndrome exceed 50%. Donor‐derived Strongyloides infection has occurred after heart, kidney, kidney‐pancreas and liver transplantation; yet, only 10% of the U.S. organ procurement organizations currently screen donors for strongyloidiasis....

Background Cytomegalovirus (CMV) infection is the most common infection following hematopoietic cell transplantation (HCT). Pre‐emptive antiviral therapy is highly effective at halting viral replication and preventing CMV disease; however, recurrence rates after clearance of CMV DNAemia are high (50‐70%). Current treatment guidelines recommend main...

Cytomegalovirus (CMV) is the most common viral infection in hematopoietic cell transplantation (HCT) recipients. We performed deep phenotyping of CMV-specific T cells to predict CMV outcomes following allogeneic HCT. By using 13-color flow cytometry, we studied ex vivo CD8+ T-cell cytokine production in response to CMV-pp65 peptides in 3 clinically...

The recent randomized controlled trial by Arreola‐Guerra et al on the use of fosfomycin trometamol (FOS) in the primary prevention of urinary tract infections (UTI) in kidney transplant recipients (KTR) found no difference in the incidence of UTI or the median time to UTI. Although in their study, FOS was not beneficial for the overall prevention o...

Background: Vancomycin-resistant enterococci are an important cause of healthcare-associated infections and are inherently resistant to many commonly used antibiotics. Linezolid is the only drug currently approved by the Food and Drug Administration (FDA) to treat vancomycin-resistant enterococci, however resistance to this antibiotic appears to b...

Lasiodiplodia theobromae is a known plant pathogen in tropical and subtropical areas. Few cases have been reported in humans (usually keratitis and endophthalmitis) with only two cases of fungal sinusitis in immunocompromised and immunocompetent patients published to date. We report a case of invasive sinusitis secondary to L. theobromae in an allo...

Strongyloides stercoralis infects up to 100 million persons worldwide.¹ Solid organ transplant (SOT) patients are at risk for hyperinfection syndrome and disseminated infection with high mortality rates.2‐3 Pre‐transplant screening is recommended in SOT candidates with epidemiological risk factors, and treatment indicated in those who test positive...

A 59‐year‐old man with non‐ischemic cardiomyopathy underwent orthotopic heart transplantation. The donor, a 31‐year‐old male declared brain dead after a gunshot wound to the head, was considered high risk due to history of incarceration, illicit drug use and sex with a HIV positive partner. At organ procurement, the heart, kidneys, pancreas and liv...

Donor-derived infections (DDIs) are a very rare but potentially devastating complication of solid organ transplantation. Here we present a cluster of proven donor-derived cryptococcal infection in the kidney, liver and lung recipients from a single donor. Remarkably, the onset of illness in the kidney and liver recipients occurred more than 8-12 we...

The optimal viral load threshold to initiate pre-emptive cytomegalovirus (CMV) therapy in hematopoietic cell transplant (HCT) recipients remains to be defined. In an effort to address this question we conducted a retrospective study of 174 allogeneic HCT recipients transplanted at a single center between August 2012 and April 2016. During this peri...

Zika virus (ZIKV) cases have been detected across the United States (US) and locally acquired cases have been reported in Florida. Currently, there are no ZIKV screening guidelines and no data on the incidence among organ donors in the US. This retrospective study was conducted at Jackson Memorial-Miami Transplant Institute. Positive ZIKV tests in...

Clinical outcomes in HIV⁺/HCV⁺ co-infected kidney transplant recipients in the pre- and post-direct acting antiviral (DAA) therapy eras: 10 year Single-center experience Background Previous studies have shown worse patient and graft survival following kidney transplant (KT) in HIV⁺/HCV⁺ co-infected patients compared with HIV⁺/HCV⁻ recipients. Howe...

Clostridium difficile infection (CDI) is a common complication among solid organ transplant (SOT) recipients with an estimated incidence of 7–31% for lung recipients, 8–15% for heart, 3-19% for liver, 9% for intestinal, 4-16% for kidney and 2-8% for pancreas-kidney recipients (1) and it is associated with increased mortality (2). There is limited d...

The management of infections with New Delhi Metallo-beta-lactamase-1 (NDM) producing bacteria remains clinically challenging given the multi-drug resistant (MDR) phenotype associated with these bacteria. Despite resistance in vitro , ceftazidime-avibactam previously demonstrated in vivo activity against NDM+ Enterobacteriaceae. Herein, we observed...

Despite the refinements in molecular methods for the detection of cytomegalovirus (CMV) and the advent of highly effective preemptive strategies, CMV remains a leading cause of morbidity and mortality in hematopoietic cell transplant (HCT) recipients. CMV can cause tissue-invasive disease including pneumonia, hepatitis, colitis, retinitis, and ence...

Organ transplantation carries a potential risk of transmission of infectious diseases and malignancy. Fortunately, donor-derived transmission events remain a rare complication of transplantation occurring in less than 1% of solid organ recipients.(1,2) Although uncommon, donor-derived infections (DDIs) can be associated with significant morbidity a...

Background: Antiretroviral therapy (ART) poses challenging drug-drug interactions with immunosuppressant agents in transplant recipients. We aimed to determine the impact of specific antiretroviral regimens in clinical outcomes of HIV ⁺ kidney transplant recipients. Methods: A single-center, retrospective cohort study was conducted at a large acade...

Latent tuberculosis infection (LTBI) is not uncommon among renal transplant candidates (RTC) [1]. Rifapentine/isoniazid (RPT/INH) administered for 12 weeks is one of the first line treatments for LTBI [1] and we have recently showed that it is associated with higher completion rates than INH monotherapy for 9 months [2]. This article is protected b...

Double-stranded DNA (dsDNA) viral infections constitute a major complication following solid organ and stem cell transplantation. Few therapeutic options are currently available for the treatment of such infections in highly immunocompromised hosts. Brincidofovir is an oral investigational drug with broad antiviral activity against dsDNA viruses in...

Objectives: We aimed to compare the antimicrobial susceptibility percentages in blood and urine bacterial isolates recovered from solid organ transplant (SOT) recipients with those reported in the hospital-wide antibiogram. Methods: Retrospective review of the antimicrobial susceptibilities of bacterial isolates recovered from SOT recipients at...

Background: Renal transplant candidates (RTC) with latent tuberculosis infection (LTBI) are at significant risk for tuberculosis reactivation. Twelve-week rifapentine (RPT)/isoniazid (INH) is effective for LTBI but clinical experience in RTC is scarce. Methods: We conducted a retrospective study of RTC with LTBI treated with either 12-week RPT/I...

Background: HIV infection is associated with high rates of acute rejection following kidney transplantation. The underlying mechanisms for such predisposition are incompletely understood. Pathological immune activation is a hallmark of chronic HIV infection that persists despite effective antiretroviral therapy. We hypothesized that the baseline l...

In current practice HIV+ candidates with CD4 >200 cells/mm3 are eligible for kidney transplantation. However, the optimal pre-transplant CD4 count above this threshold remains to be defined. We evaluated clinical outcomes in patients with baseline CD4 >350 and <350 cells/mm3 among 38 anti-thymocyte globulin (ATG)-treated HIV- to HIV+ kidney transpl...

New antibiotic options are urgently needed for the treatment of carbapenem-resistant Enterobacteriaceae infections. We report a 64-year-old female with prolonged hospitalization following an intestinal transplant who developed refractory bacteremia due to a serine carbapenemase-producing pandrug-resistant isolate of Klebsiella pneumoniae. After fai...

Simkins, J, Aragon, L, Fan, J, Frederick, C, Camargo, J. F. Intravenous Fosfomycin Treatment for Carbapenem-Resistant Klebsiella pneumoniae in the United States. Ann Pharmacother. 2015;49:1177-1178 (Original doi: 10.1177/1060028015598326). On page 1177, Dr. Jose F. Camargo is listed as the 3(rd) author. However, he should be the last author in the...

Lipid formulations of amphotericin B remain the first-line antifungal therapy for invasive mucormycosis. Posaconazole is an alternative for salvage therapy, but its use as primary therapy is not recommended due to the paucity of clinical data. Here we describe the case of a 57-year-old diabetic woman receiving etanercept and prednisone for the trea...

Invasive mold infections (IMI) are among the most devastating complications following chemotherapy and hematopoietic stem cell transplantation (HSCT), with high mortality rates. Yet, the molecular basis for human susceptibility to invasive aspergillosis (IA) and mucormycosis remain poorly understood. Herein, we aimed to characterize the immune prof...

CCR6 is a chemokine receptor involved in homing memory T cells, particularly Th17 cells, to sites of mucosal inflammation. Despite the critical role of memory T cells in long-term protective immunity against CMV, a virus that reactivates at multiple mucosal sites, the ability of CCR6 or other Th17 marker expression to predict CMV reactivation follo...

Importance: In individuals with human immunodeficiency virus 1 (HIV-1) infection who are receiving antiretroviral therapy (ART), factors that promote full immune recovery are not well characterized. Objective: To investigate the influence of the timing of ART relative to HIV-1 infection on normalization of CD4+ T-cell counts, AIDS risk, and immu...

BACKGROUND: Powassan virus, a member of the tick-borne encephalitis group of flaviviruses, encompasses two lineages with separate enzootic cycles. The prototype lineage of Powassan virus (POWV) is principally maintained between Ixodes cookei and the groundhog (Marmota momax) or striped skunk (Mephitis mephitis), while the deer tick virus (DTV) line...

Protective immunity against Aspergillus depends on a highly coordinated interaction between the innate and adaptive arms of the immune system. Fungal recognition via pattern recognition receptors such as Pentraxin 3, Dectin-1 and Toll-like receptors leads to complement activation, phagocytosis and killing of ingested fungi. Aspergillus-specific T h...

Powassan virus, a member of the tick-borne encephalitis group of flaviviruses, encompasses 2 lineages with separate enzootic cycles. The prototype lineage of Powassan virus (POWV) is principally maintained between Ixodes cookei ticks and the groundhog (Marmota momax) or striped skunk (Mephitis mephitis), whereas the deer tick virus (DTV) lineage is...

Septic pulmonary embolism (SPE) results when fragments of thrombus containing bacteria or fungi travel to the pulmonary circulation and lodge in segmental and subsegmental pulmonary arteries. Almost invariably such embolization implies the presence of an endovascular infection (typically endocarditis, septic thrombophlebitis, or catheter-related in...

We report a case of MonoMAC syndrome in a patient with a GATA2 mutation and discuss the manifestations, diagnosis and treatment of this novel immunodeficiency disorder.

We report a rare case of orbital apex syndrome following epidural steroid injections of the lumbar spine in an immunocompetent individual with osteomyelitis and discitis caused by Aspergillus fumigatus. We suspect that the craniospinal venous system, also known as the Batson's plexus, was the main route for steroid-facilitated disease propagation f...

Despite suppression of the human immunodeficiency virus type 1 (HIV-1) load by highly active antiretroviral therapy (HAART), recovery of CD4+ T cell counts can be impaired. We investigated whether this impairment may be associated with hyporesponsiveness of T cells to gamma-chain (gammac) cytokines known to influence T cell homeostasis. The respons...

Ligands of CCR5, the major coreceptor of HIV-1, costimulate T lymphocyte activation. However, the full impact of CCR5 expression on T cell responses remains unknown. Here, we show that compared with CCR5(+/+), T cells from CCR5(-/-) mice secrete lower amounts of IL-2, and a similar phenotype is observed in humans who lack CCR5 expression (CCR5-Delt...

Supplemental Online Materials - Text (0.07 MB DOC)

Replication of results of CART analysis in the seroprevalent component of the WHMC HIV+ cohort. (0.31 MB TIF)

Classification trees and their clinical application in the HIV+ WHMC cohort. (0.35 MB TIF)