An immune reconstitution syndrome-like illness associated with Cryptococcus neoformans infection in organ transplant recipients

Singh, Nina, Lortholary, Olivier, Alexander, Barbara D., Gupta, Krishan L., John, George T., Pursell, Kenneth, 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, Garcia-Diaz, Julia, Kalil, Andre C., Fisher, Robert A., Husain, Shahid and Cryptococcal Collaborative Transplant Study Group (2005) An immune reconstitution syndrome-like illness associated with Cryptococcus neoformans infection in organ transplant recipients. Clinical Infectious Diseases, 40 12: 1756-1761. doi:10.1086/430606


Author Singh, Nina
Lortholary, Olivier
Alexander, Barbara D.
Gupta, Krishan L.
John, George T.
Pursell, Kenneth
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
Garcia-Diaz, Julia
Kalil, Andre C.
Fisher, Robert A.
Husain, Shahid
Cryptococcal Collaborative Transplant Study Group
Title An immune reconstitution syndrome-like illness associated with Cryptococcus neoformans infection in organ transplant recipients
Formatted title
An immune reconstitution syndrome-like illness associated with Cryptococcus neoformans infection in organ transplant recipients
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1058-4838
1537-6591
Publication date 2005-06
Sub-type Article (original research)
DOI 10.1086/430606
Volume 40
Issue 12
Start page 1756
End page 1761
Total pages 6
Place of publication Cary, NC, United States
Publisher Oxford University Press
Language eng
Formatted abstract
Background. We describe an immune reconstitution syndrome (IRS)–like entity in the course of evolution of Cryptococcus neoformans infection in organ transplant recipients.
Methods. The study population comprised a cohort of 83 consecutive organ transplant recipients with cryptococcosis who were observed for a median of 2 years in an international, multicenter study.
Results. In 4 (4.8%) of the 83 patients, an IRS-like entity was observed a median of 5.5 weeks after the initiation of appropriate antifungal therapy. Worsening of clinical manifestations was documented, despite cultures being negative for C. neoformans. These patients were significantly more likely to have received tacrolimus, mycophenolate mofetil, and prednisone as the regimen of immunosuppressive therapy than were all other patients (P = .007). The proposed basis of this phenomenon is reversal of a predominantly Th2 response at the onset of infection to a Th1 proinflammatory response as a result of receipt of effective antifungal therapy and a reduction in or cessation of immunosuppressive therapy.
Conclusions. This study demonstrated that an IRS-like entity occurs in organ transplant recipients with C. neoformans infection. Furthermore, this entity may be misconstrued as a failure of therapy. Immunomodulatory agents may have a role as adjunctive therapy in such cases.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
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