Unrecognized pretransplant and donor-derived cryptococcal disease in organ transplant recipients

Sun, Hsin-Yun, Alexander, Barbara D., Lortholary, Olivier, Dromer, Francoise, Forrest, Graeme N., Lyon, G. Marshall, Somani, Jyoti, Gupta, Krishan L., del Busto, Ramon, Pruett, Timothy L., Sifri, Costi D., Limaye, Ajit P., John, George T., Klintmalm, Goran B., Pursell, Kenneth, Stosor, Valentina, Morris, Michele I., Dowdy, Lorraine A., Munoz, Patricia, Kalil, Andre C., Garcia-Diaz, Julia, Orloff, Susan L., House, Andrew A., Houston, Sally H., Wray, Dannah, Huprikar, Shirish, Johnson, Leonard B., Humar, Atul, Razonable, Raymund R., Fisher, Robert A., Husain, Shahid, Wagener, Marilyn M., Singh, Nina and Cryptococcal Collaborative Transplant Study Group (2010) Unrecognized pretransplant and donor-derived cryptococcal disease in organ transplant recipients. Clinical Infectious Diseases, 51 9: 1062-1069. doi:10.1086/656584


Author Sun, Hsin-Yun
Alexander, Barbara D.
Lortholary, Olivier
Dromer, Francoise
Forrest, Graeme N.
Lyon, G. Marshall
Somani, Jyoti
Gupta, Krishan L.
del Busto, Ramon
Pruett, Timothy L.
Sifri, Costi D.
Limaye, Ajit P.
John, George T.
Klintmalm, Goran B.
Pursell, Kenneth
Stosor, Valentina
Morris, Michele I.
Dowdy, Lorraine A.
Munoz, Patricia
Kalil, Andre C.
Garcia-Diaz, Julia
Orloff, Susan L.
House, Andrew A.
Houston, Sally H.
Wray, Dannah
Huprikar, Shirish
Johnson, Leonard B.
Humar, Atul
Razonable, Raymund R.
Fisher, Robert A.
Husain, Shahid
Wagener, Marilyn M.
Singh, Nina
Cryptococcal Collaborative Transplant Study Group
Title Unrecognized pretransplant and donor-derived cryptococcal disease in organ transplant recipients
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1058-4838
1537-6591
Publication date 2010-11-01
Sub-type Article (original research)
DOI 10.1086/656584
Open Access Status Not yet assessed
Volume 51
Issue 9
Start page 1062
End page 1069
Total pages 8
Editor Sherwood L. Gorbach
Place of publication Cary, NC, U.S.A.
Publisher Oxford University Press
Language eng
Formatted abstract
Background: Cryptococcosis occurring ≤30 days after transplantation is an unusual event, and its characteristics are not known.

Methods: Patients included 175 solid-organ transplant (SOT) recipients with cryptococcosis in a multicenter cohort. Very early-onset and late-onset cryptococcosis were define as disease occurring ≤30 days or >30 days after transplantation, respectively.

Results: Very early-onset disease developed in 9 (5%) of the 175 patients at a mean of 5.7 days after transplantation. Overall, 55.6% (5 of 9) of the patients with very early-onset disease versus 25.9% (43 of 166) of the patients with late-onset disease were liver transplant recipients (P = .05). Very early cases were more likely to present with disease at unusual locations, including transplanted allograft and surgical fossa/site infections (55.6% vs 7.2%; P < .001). Two very early cases with onset on day 1 after transplantation (in a liver transplant recipient with Cryptococcusisolated from the lung and a heart transplant recipient with fungemia) likely were the result of undetected pretransplant disease. An additional 5 cases involving the allograft or surgical sites were likely the result of donor-acquired infection.

Conclusions: A subset of SOT recipients with cryptococcosis present very early after transplantation with disease that appears to occur preferentially in liver transplant recipients and involves unusual sites, such as the transplanted organ or the surgical site. These patients may have unrecognized pretransplant or donor-derived cryptococcosis.
© 2010 by the Infectious Diseases Society of America. All rights reserved.
Keyword Invasive fungal-infections
Hematopoietic stem-cell
Solid-organ
Neoformans infection
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
 
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Created: Mon, 28 Mar 2011, 21:27:19 EST by Debbie Banks on behalf of School of Medicine