Antifungal management practices and evolution of infection in organ transplant recipients with Cryptococcus neoformans infection

Singh, Nina, Lortholary, Olivier, Alexander, Barbara D., Gupta, Krishan L., John, George T., Pursell, Kenneth J., Munoz, Patricia, Klintmalm, Goran B., Stosor, Valentina, del Busto, Ramon, Limaye, Ajit P., Somani, Jyoti, Lyon, Marshall, Houston, Sally, House, Andrew A., Pruett, Timothy L., Orloff, Susan, Humar, Atul, Dowdy, Lorraine A., Garcia-Diaz, Julia, Kalil, Andre C., Fisher, Robert A., Heitman, Joseph and Husain, Shahid (2005) Antifungal management practices and evolution of infection in organ transplant recipients with Cryptococcus neoformans infection. Transplantation, 80 8: 1033-1039. doi:10.1097/01.tp.0000173774.74388.49


Author Singh, Nina
Lortholary, Olivier
Alexander, Barbara D.
Gupta, Krishan L.
John, George T.
Pursell, Kenneth J.
Munoz, Patricia
Klintmalm, Goran B.
Stosor, Valentina
del Busto, Ramon
Limaye, Ajit P.
Somani, Jyoti
Lyon, Marshall
Houston, Sally
House, Andrew A.
Pruett, Timothy L.
Orloff, Susan
Humar, Atul
Dowdy, Lorraine A.
Garcia-Diaz, Julia
Kalil, Andre C.
Fisher, Robert A.
Heitman, Joseph
Husain, Shahid
Title Antifungal management practices and evolution of infection in organ transplant recipients with Cryptococcus neoformans infection
Journal name Transplantation   Check publisher's open access policy
ISSN 0041-1337
Publication date 2005-10
Sub-type Article (original research)
DOI 10.1097/01.tp.0000173774.74388.49
Volume 80
Issue 8
Start page 1033
End page 1039
Total pages 7
Place of publication United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Background.
Therapeutic practices for Cryptococcus neoformans infection in transplant recipients vary, particularly with regards to antifungal agent employed, and duration of therapy. The risk of relapse and time to recurrence is not known. We assessed antifungal treatment practices for cryptococcosis in a cohort of prospectively followed organ transplant recipients.

Methods.
The patients comprised 83 transplant recipients with cryptococcosis followed for a median of 2.1 and up to 5.2 years.

Results.
Patients with central nervous system infection (69% vs. 16%, P = 0.00001), disseminated infection (82.7% vs. 20%, P = 0.00001), and fungemia (29% vs. 8%, P = 0.046) were more likely to receive regimens containing amphotericin B than fluconazole as primary therapy. The use of fluconazole, on the other hand, was more likely for infection limited to the lungs (64% vs. 14%, P = 0.00002). Survival at 6 months tended to be lower in patients whose CSF cultures at 2 weeks were positive compared to those whose CSF cultures were negative (50% vs. 91%, P = 0.06). Maintenance therapy was employed in 68% (54/79) of the patients who survived >3 weeks. The median duration of maintenance therapy was 183 days; 55% received maintenance for ≥ 6 months and 25% for >1 year. Relapse was documented in 1.3% (1/79) of the patients.

Conclusions.
A majority of the organ transplant recipients with cryptococcosis receive maintenance antifungal therapy for 6 months with low risk of relapse. These data can assist in trials to assess the optimal therapeutic approach and duration of therapy for cryptococcosis in transplant recipients.
Keyword Cryptococcus
Fungal infection
Transplant
Acquired-Immunodeficiency-Syndrome
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collections: ERA 2012 Admin Only
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