About

Dr. Daniel Zachary Friedman is an Assistant Professor of Medicine in the Department of Medicine at The University of Chicago. His clinical and research focus is on managing infectious diseases in immunocompromised hosts, particularly those who have undergone solid organ transplants, stem cell transplants, or have cancer. He is dedicated to evaluating patients prior to transplantation to help reduce infectious risks and to developing customized preventive strategies. Dr. Friedman has a specific interest in invasive fungal infections, studying their epidemiology in transplant recipients, and participating in clinical trials for novel antifungal treatments. His recent work includes research on the burden of invasive fungal disease following Chimeric Antigen Receptor T-Cell therapy and strategies for its prevention.

Research topics

• Medicine
• Internal medicine
• Biology
• Microbiology
• Intensive care medicine
• Gastroenterology
• Immunology
• Pathology
• Genetics

Selected publications

• Fungal diagnostic stewardship in immunocompromised populations: a focus on molds and dimorphic fungi

  Clinical Microbiology Reviews · 2026-02-12

  articleOpen access

  SUMMARYInvasive fungal diseases cause severe illness and death in immunocompromised patients. Antifungal use is increasingly common, as is fungal diagnostic testing. However, these efforts have not been guided by traditional stewardship efforts akin to those used for bacterial infections. Fungal diagnostic stewardship can have a significant impact on the care of vulnerable patients, including decreasing unnecessary testing while increasing appropriate testing and improving testing strategies to reduce diagnostic errors. In this review, we discuss the most frequently used fungal diagnostic assays for molds and dimorphic fungal infections, their diagnostic performance for these organisms in immunocompromised hosts, and strategies to improve diagnostic stewardship and ultimately patient outcomes.

  PublisherOA PDFDOI

• Risk factors and outcomes of Pneumocystis jirovecii pneumonia in kidney transplant recipients: A case-control study of the United States Renal Data System

  American Journal of Transplantation · 2025-12-17 · 1 citations

  article
  PublisherDOI

• P-960. Improving Resident Education on the Inpatient Infectious Disease Consult Service

  Open Forum Infectious Diseases · 2025-01-29

  articleOpen access

  Abstract Background Education in infectious disease (ID) is a critical part of an internal medicine curriculum. As the infectious disease consult service is typically high volume and busy, residents and other trainees were often not receiving adequate training in less common infectious conditions or didactic training in common conditions that may be relevant for their future practice or internal medicine board exams. Our Quality Improvement project sought to improve training for residents and medical students through the integration of high-yield lecture services given on the Adult ID consult service.Figure 1:Pre/Post Test Results of Internal Medicine Residents These are the reported correct responses, in terms of percentage of residents who responded correctly to the case-based multiple choice question, to a pre and post test of six specific high-yield topics in Infectious Diseases. Methods During the academic year of 2022-2023, for the Adult ID Consult Service, a series of high-yield lectures were given three times a week from a set of 10 potential lecture topics, as chosen by the volunteer faculty or ID fellow lecturer. Following our first Plan-Do-Study-Act cycle evaluation in July 2023, the lectures were standardized to a fixed rotating schedule of the 6 highest-yield topics. There was distributed a survey with a pre-test before the rotation, and a follow-up survey and post-test following the rotation. Post-intervention Interest in Career in ID among Internal Medicine Residents 15.4% (n=2) of internal medicine residents responded yes they would, and 38.5% (n=5) responded somewhat more likely, to consider a career in Infectious Diseases (ID) following the rotation. Results 44 Internal Medicine Residents took the initial Adult ID survey and pretest, and 13 people took the post-rotation evaluation survey and post-test. 100% of participants felt the rotation fully or somewhat helped prepare for the Adult ID section of Internal Medicine boards. 92.3% (n=12) felt the majority of cases on rotation to be interesting. 15.4% (n=2) responded yes and 38.5% (n=5) responded somewhat more likely to consider ID as a career. 100% (n=13) of post-test participants responded with strongly agree (n=7, 53.8%) or agree (n=6, 46.2%) on enjoying the Adult ID rotation. Additionally, scores on the post-test improved from the pre-test for most residents, along with an improvement in Internal Medicine in-training exam scores from 2021 to 2023. Conclusion A didactic series with a set lesson plan that is delivered in a low-stress way can be helpful for engaging learners, enhance the educational experience of the learner, help supplement preparation for internal medicine board exams, and prepare the learner for their future practice. Additionally, as there is a growing need for infectious diseases fellows, this may improve recruitment efforts. Disclosures Aniruddha Hazra, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|ViiV Healthcare: Advisor/Consultant

  PublisherOA PDFDOI

• An Unexpectedly High Incidence of Invasive Fungal Diseases in Solid Organ Transplant Recipients Taking Belatacept for Organ Rejection Prophylaxis: A Single-Center Retrospective Cohort Study

  Open Forum Infectious Diseases · 2024-03-16 · 8 citations

  articleOpen accessSenior authorCorresponding

  Among solid organ transplant recipients taking belatacept, 15% developed invasive fungal diseases. The most common invasive fungal diseases were aspergillosis (56%) and candidiasis (22%). The infected cohort was more likely to receive basiliximab, undergo lung transplantation, or identify as White. Higher rates of aspergillosis were seen in this lung cohort than previously reported.

  PublisherOA PDFDOI

• The Burden of Invasive Fungal Disease Following Chimeric Antigen Receptor T-Cell Therapy and Strategies for Prevention

  Open Forum Infectious Diseases · 2024-03-13 · 34 citations

  articleOpen access

  Chimeric antigen receptor (CAR) T-cell therapy is a novel immunotherapy approved for the treatment of hematologic malignancies. This therapy leads to a variety of immunologic deficits that could place patients at risk for invasive fungal disease (IFD). Studies assessing IFD in this setting are limited by inconsistent definitions and heterogeneity in prophylaxis use, although the incidence of IFD after CAR T-cell therapy, particularly for lymphoma and myeloma, appears to be low. This review evaluates the incidence of IFD after CAR T-cell therapy, and discusses optimal approaches to prevention, highlighting areas that require further study as well as future applications of cellular therapy that may impact IFD risk. As the use of CAR T-cell therapy continues to expand for hematologic malignancies, solid tumors, and most recently to include non-oncologic diseases, understanding the risk for IFD in this uniquely immunosuppressed population is imperative to prevent morbidity and mortality.

  PublisherOA PDFDOI

• Reply to Heldman et al

  Open Forum Infectious Diseases · 2024-05-20 · 1 citations

  articleOpen accessSenior author

  We appreciate Heldman and colleagues' interest in our study [1,2], highlighting the challenges involved in research of fungal infections, and allowing us to clarify some key points.Although not expressly written due to word count restraints, we assure that the standardized definitions from the most recent European Organization for the Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) were used to classify our cases [3].Our decision to include cases of possible Invasive Fungal Diseases (IFD) was based on thorough chart reviews where there was compelling evidence justifying the treatment of fungal infection, even if these infections did not strictly meet the criteria of probable or proven.By adopting this approach, we aimed to capture a broader spectrum of clinically significant cases.Additionally, the studies we referenced to elucidate the incidence of fungal infections in solid organ transplant (SOT) recipients on belatacept did not explicitly communicate this "proven, probable, possible" schema, which would have provided clarity regarding the confidence level of fungal infection diagnosis.As underscored by Heldman and colleagues, discriminating between airway colonization and invasive pulmonary or tracheobronchial infections presents inherent challenges in retrospective reviews.We concur that misclassification, such as labeling

  PublisherOA PDFDOI

• Outcomes in solid organ transplant recipients receiving organs from a donor with <i>Fusarium solani</i> species complex meningitis

  Transplant Infectious Disease · 2024-07-16 · 4 citations

  articleOpen access

  BACKGROUND: Five organs (heart, right lung, liver, right, and left kidneys) from a deceased patient were transplanted into five recipients in four US states; the deceased patient was identified as part of a healthcare-associated fungal meningitis outbreak among patients who underwent epidural anesthesia in Matamoros, Mexico. METHODS: After transplant surgeries occurred, Fusarium solani species complex, a fungal pathogen with a high case-mortality rate, was identified in cerebrospinal fluid from the organ donor by metagenomic next-generation sequencing (mNGS) and fungal-specific polymerase chain reaction and in plasma by mNGS. RESULTS: Four of five transplant recipients received recommended voriconazole prophylaxis; four were monitored weekly by serum (1-3)-β-d-glucan testing. All five were monitored for signs of infection for at least 3 months following transplantation. The liver recipient had graft failure, which was attributed to an etiology unrelated to fungal infection. No fungal DNA was identified in sections of the explanted liver, suggesting that F. solani species complex did not contribute to graft failure. The remaining recipients experienced no signs or symptoms suggestive of fusariosis. CONCLUSION: Antifungal prophylaxis may be useful in preventing donor-derived infections in recipients of organs from donors that are found to have Fusarium meningitis.

  PublisherOA PDFDOI

• Serial Bronchoalveolar Lavage Fluid <i>Aspergillus</i> Galactomannan and Treatment Response in Invasive Pulmonary Aspergillosis

  Open Forum Infectious Diseases · 2024-03-01 · 8 citations

  articleOpen access1st author

  Abstract We studied patients diagnosed with aspergillosis based on positive bronchoalveolar lavage (BAL) Aspergillus galactomannan (GM) who had follow-up BAL sampling within 180 days. GM trend and clinical outcome were concordant in only 60% (30/50). While useful for the initial diagnosis, BAL GM trending does not always correlate with treatment response.

  PublisherOA PDFDOI

• 830. Risk factors for late Pneumocystis jirovecii pneumonia in kidney transplant recipients: A Case-Control Study of United States Renal Data System Data

  Open Forum Infectious Diseases · 2023-11-27

  articleOpen accessSenior author

  Abstract Background Organ transplant recipients are at increased risk of potentially life-threatening opportunistic infections, including Pneumocystis jirovecii pneumonia (PJP). Given the use of effective prophylaxis, PJP has become less common, especially during the first-year post-transplant. Recent data has shown that the risk of infection has shifted within the first 2 years after discontinuing prophylaxis. We aimed to determine risk factors for late posttransplant PJP using a national database. Methods Using the United States Renal Data System database, we performed a retrospective case-control study of patients who underwent kidney transplant from 1998 through 2019. To evaluate risk factors for late PJP, we performed logistic regression analysis by comparing characteristics between infected patients and their matched uninfected controls. Results We identified 407 cases with PJP and matched to 1628 controls (1:4). 60 (14.7%) of the cases occurred within one year post transplant and 347 (85.3%) patients were diagnosed after one year of transplant. In the late period, the median time between transplant and PJP diagnosis was 68.7 (IQR 28 -134.2) months. Seventy cases (20.1%) occurred between 12 and 24 months. In multivariate analysis (table 1), risk factors for late infection included a higher Elixhauser Comorbidity Index (ECI), history of cytomegalovirus disease, older donor age, use of antilymphocyte agents, history of re-transplant and a longer time of hemodialysis prior to transplant. Of note, in the early period, we found that having a living donor was protective. Multivariate analysis of risk factors for late Pneumocystis jirovecii pneumonia Conclusion Our findings highlight the importance of a timely transplant to mitigate the risk of post-transplant PJP in the late post-transplant period where prophylaxis is not routinely used. These results also raise the consideration of PJP prophylaxis in the late period in patients diagnosed with CMV disease, history of re transplant and recent use of antilymphocyte agents. Disclosures Paschalis Vergidis, MD, MSc, AbbVie: Advisor/Consultant|Ansun: Grant/Research Support|Cidara: Grant/Research Support|Scynexis: Grant/Research Support

  PublisherOA PDFDOI

• Emerging Diagnostics and Therapeutics for Invasive Fungal Infections

  Infectious Disease Clinics of North America · 2023-08-02 · 21 citations

  review1st author
  PublisherDOI

Frequent coauthors

• Paschalis Vergidis

  Mayo Clinic in Arizona

  17 shared

• Raymund R. Razonable

  Mayo Clinic

  10 shared

• Elena Beam

  Mayo Clinic

  7 shared

• Holenarasipur R. Vikram

  Mayo Clinic Hospital

  6 shared

• Supavit Chesdachai

  Mayo Clinic in Florida

  6 shared

• Omar Abu Saleh

  Mayo Clinic in Arizona

  4 shared

• Maryam Mahmood

  Mayo Clinic in Florida

  4 shared

• Jennifer Pisano

  University of Chicago

  3 shared

Education

• Master of Science, Medicine

  University of Alberta

  2020

• Doctor of Medicine, Faculty of Medicine and Dentistry

  University of Alberta

  2015

• Bachelor of Science, Faculty of Science, Department of Anatomy and Cell Biology

  McGill University

  2011