Cryptococcal meningitis: an analysis among 5521 consecutive organ transplant recipients

Abstract

Cryptococcal meningitis has been reported to be an important cause of morbidity and mortality in renal transplant recipients. However, additional studies of recipients of other organ transplants suggested that these patients might be at low risk for cryptococcal meningitis. We examined the incidence and clinical features of cryptococcal meningitis among different groups of organ transplant patients at the University of Pittsburgh Medical Center. From January 1989 through July 1999, 28 patients were diagnosed with cryptococcal meningitis among 5,521 transplant recipients. These included liver (11/2,539), heart (8/372), kidney (7/2,122), lung (1/432), and small bowel (1/56) recipients. The incidence of cryptococcal meningitis was higher in heart and small bowel recipients compared to other transplant populations (P = 0.005). The cryptococcal meningitis-related mortality in transplant recipients was 50% and was associated with altered mental status (P = 0.001), absence of headache (P = 0.02), and liver failure (P = 0.002). Multivariable analysis indicated that liver failure was the only independent risk factor for poor prognosis (P = 0.043). All cases of liver failure occurred among liver transplant recipients. Cryptococcal meningitis is associated with significant mortality among organ transplant recipients. The presence of allograft failure in liver transplant recipients with cryptococcal meningitis may be an indicator of poor prognosis in this patient population.

Cryptococcal panniculitis in a renal transplant recipient: case report and review of literature

“…6 Cryptococcosis represented 3% to 8% of the invasive fungal infections in solid organ transplant (SOT) recipients with an overall mortality of 42%. 2 In SOT patients cryptococcosis manifests as a late occurring infection with most cases occuring more than 6 months post transplant; the median time to onset was 16 to 21 months after transplantation. 7 In transplant recipients, the reduction of immune defences, induced by drugs, may lead to extra pulmonary haematogenous dissemination of cryptococci, with the involvement of other organs, usually the central nervous system (CNS), as well as the skin, urinary tract, bones and joints.…”

“…In transplant recipients, infection with cryptococcal species presents across a wide spectrum usually as meningoencephalitis and pneumonitis, with cutaneous infections appearing uncommonly. 2 Cutaneous cryptococcosis can have drastically varied presentations, from papules to a more subtle cellulitis and mimic other dermatological entities. Cutaneous lesions have to be considered seriously because they may be the first clinical sign of cryptococcosis and may be an indicator of systemic dissemination.…”

The Neurology of Solid Organ Transplantation

“…Fungal Infections Cryptococcus neoformans is the most common cause of fungal meningitis in SOT recipients, with higher risk after heart and intestinal transplantation [40]. It usually occurs late in the posttransplant period, with a mean reported onset at 28 months after transplantation [40].…”

Infections After Orthotopic Liver Transplantation

“…71 Patients with cryptococcal CNS involvement may not display classic signs of meningitis such nuchal rigidity, photophobia, or headache. 72 A low threshold must be held to perform lumbar puncture.…”