Central nervous system cryptococcosis in solid organ transplant recipients: Clinical relevance of abnormal neuroimaging findings

Singh, Nina, Lortholary, Olivier, Dromer, Francoise, Alexander, Barbara D., Gupta, Krishan L., John, George T., del Busto, Ramon, Klintmalm, Goran B., Somani, Jyoti, Lyon, G. Marshall, Pursell, Kenneth, Stosor, Valentina, Munoz, Patricia, Limaye, Ajit P., Kalil, Andre C., Pruett, Timothy L., Garcia-Diaz, Julia, Humar, Atul, Houston, Sally, House, Andrew A., Wray, Dannah, Orloff, Susan, Dowdy, Lorraine A., Fisher, Robert A., Heitman, Joseph, Wagener, Marilyn M., Husain, Shahid and and the Cryptococcal Collaborative Transplant Study Group (2008) Central nervous system cryptococcosis in solid organ transplant recipients: Clinical relevance of abnormal neuroimaging findings. Transplantation, 86 5: 647-651. doi:10.1097/TP.0b013e3181814e76

Author Singh, Nina
Lortholary, Olivier
Dromer, Francoise
Alexander, Barbara D.
Gupta, Krishan L.
John, George T.
del Busto, Ramon
Klintmalm, Goran B.
Somani, Jyoti
Lyon, G. Marshall
Pursell, Kenneth
Stosor, Valentina
Munoz, Patricia
Limaye, Ajit P.
Kalil, Andre C.
Pruett, Timothy L.
Garcia-Diaz, Julia
Humar, Atul
Houston, Sally
House, Andrew A.
Wray, Dannah
Orloff, Susan
Dowdy, Lorraine A.
Fisher, Robert A.
Heitman, Joseph
Wagener, Marilyn M.
Husain, Shahid
and the Cryptococcal Collaborative Transplant Study Group
Title Central nervous system cryptococcosis in solid organ transplant recipients: Clinical relevance of abnormal neuroimaging findings
Journal name Transplantation   Check publisher's open access policy
ISSN 0041-1337
Publication date 2008-09-01
Sub-type Article (original research)
DOI 10.1097/TP.0b013e3181814e76
Volume 86
Issue 5
Start page 647
End page 651
Total pages 5
Language eng
Formatted abstract
Background. Prognostic implications of cryptococcal antigen and outcomes associated with central nervous system (CNS) cryptococcal lesions in solid organ transplant recipients have not been fully defined.

Methods. Patients were derived form a cohort of 122 solid organ transplant recipients with cryptococcosis in a multicenter study from 1999 to 2006.

Results. Central nervous system cryptococcosis was documented in 61 patients. Serum or cerebral spinal fluid antigen titers did not correlate with mortality at 90 days or cerebral spinal fluid sterilization at 2 weeks. Central nervous system lesions were identified in 16 patients and included leptomeningeal lesions in eight, parenchymal lesions in six, and hydrocephalus in two. Overall, 13/16 CNS lesions were present at the time of diagnosis. One parenchymal and two hydrocephalus lesions, however, developed after diagnosis and fulfilled the criteria for immune reconstitution syndrome. Cerebral spinal fluid antigen titers were higher with meningeal versus parenchymal lesions, and hydrocephalus (P = 0.015). Mortality was 50% (3/6) for patients with parenchymal, 12.5% (1/8) for those with leptomeningeal, and 0/3 for patients with hydrocephalus. Mortality was 31% (4/13) for patients with CNS lesions at baseline and 0/3 in those with new onset lesions.

. Despite a higher antigen titer with meningeal lesions, outcomes tended to be worse with parenchymal compared with meningeal lesions or hydrocephalus. New onset CNS lesions may represent immune reconstitution syndrome and seemed to be associated with better outcome.
Keyword Cryptococcosis
Central nervous system infection
C. neoformans
Cryptococcal antigen
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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