Cryptococcus neoformansInfection in Organ Transplant Recipients: Variables Influencing Clinical Characteristics and Outcome

Abstract

Unique clinical characteristics and other variables influencing the outcome of Cryptococcus neoformans infection in organ transplant recipients have not been well defined. From a review of published reports, we found that C. neoformans infection was documented in 2.8% of organ transplant recipients (overall death rate 42%). The type of primary immunosuppressive agent used in transplantation influenced the predominant clinical manifestation of cryptococcosis. Patients receiving tacrolimus were significantly less likely to have central nervous system involvement (78% versus 11%, p =0.001) and more likely to have skin, soft-tissue, and osteoarticular involvement (66% versus 21%, p = 0.006) than patients receiving nontacrolimus- based immunosuppression. Renal failure at admission was the only independently significant predictor of death in these patients (odds ratio 16.4, 95% CI 1.9-143, p = 0.004). Hypotheses based on these data may elucidate the pathogenesis and may ultimately guide the management of C. neoformans infection in organ transplant recipients.

Non-neoformans Cryptococcal Infections: a Systematic Review

“…Other recognized risk factors include use of steroid or chemotherapeutic agents, organ transplantation [13], impaired humoral immunity such as hyper-IgM syndrome [18][19][20], non-HIV lymphopenia [21], and direct or indirect exposures to pigeon excreta [22,23]. The majority (48%) of non-neoformans cryptococcal cases had impaired cell-mediated immunity (i.e., neutropenia, hematologic malignancy, steroid or immunosuppressive drug use, or organ transplantation) while 16% had comorbid HIV infection with a mean CD4 count < 100 cells/µl.…”

Pulmonary cryptococcosis: A rare but emerging disease

“…Although nodules are also identifi ed in this population, they are less frequent, likely because of their decreased ability to mount an adequate granulomatous response. Pleural effusions are uncommon, but when identifi ed portend a worse prognosis [4,5,17,20,23,25,[34][35][36][37].…”

Cryptococcal Meningitis: Current Approaches to Management in Patients With and Without AIDS

“…Among solid-organ transplant recipients, cryptococcosis is the third most common invasive fungal infection, and disseminated disease and CNS involvement occur in up to 60% of cases [22,23]. Data concerning this population are limited to retrospective series and small prospective studies, leading to management recommendations that differ somewhat from HIVpositive patients because of the prevalence of preexisting renal dysfunction and ongoing iatrogenic immunosuppression.…”