Central nervous system cryptococcosis in solid organ transplant recipients

Clinical relevance of abnormal neuroimaging findings

Nina Singh, Olivier Lortholary, Françoise Dromer, Barbara D. Alexander, Krishan L. Gupta, George T. John, Ramon Del Busto, Goran B. Klintmalm, Jyoti Somani, G. Marshall Lyon, Kenneth Pursell, Valentina Stosor, Patricia Muňoz, Ajit P. Limaye, Andre C Kalil, Timothy L. Pruett, Julia Garcia-Diaz, Atul Humar, Sally Houston, Andrew A. House & 7 others Dannah Wray, Susan Orloff, Lorraine A. Dowdy, Robert A. Fisher, Joseph Heitman, Marilyn M. Wagener, Shahid Husain

Research output: Contribution to journalArticle

44 Citations (Scopus)

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. CONCLUSIONS.: 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.

Original languageEnglish (US)
Pages (from-to)647-651
Number of pages5
JournalTransplantation
Volume86
Issue number5
DOIs
StatePublished - Sep 15 2008

Fingerprint

Cryptococcosis
Neuroimaging
Hydrocephalus
Central Nervous System
Transplants
Immune Reconstitution Inflammatory Syndrome
Antigens
Mortality
Multicenter Studies
Transplant Recipients
Serum

Keywords

  • C. neoformans
  • Central nervous system infection
  • Cryptococcal antigen
  • Cryptococcosis
  • Transplants

ASJC Scopus subject areas

  • Transplantation

Cite this

Singh, N., Lortholary, O., Dromer, F., Alexander, B. D., Gupta, K. L., John, G. T., ... Husain, S. (2008). Central nervous system cryptococcosis in solid organ transplant recipients: Clinical relevance of abnormal neuroimaging findings. Transplantation, 86(5), 647-651. https://doi.org/10.1097/TP.0b013e3181814e76

Central nervous system cryptococcosis in solid organ transplant recipients : Clinical relevance of abnormal neuroimaging findings. / Singh, Nina; Lortholary, Olivier; Dromer, Françoise; Alexander, Barbara D.; Gupta, Krishan L.; John, George T.; Del Busto, Ramon; Klintmalm, Goran B.; Somani, Jyoti; Lyon, G. Marshall; Pursell, Kenneth; Stosor, Valentina; Muňoz, 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.

In: Transplantation, Vol. 86, No. 5, 15.09.2008, p. 647-651.

Research output: Contribution to journalArticle

Singh, N, Lortholary, O, Dromer, F, Alexander, BD, Gupta, KL, John, GT, Del Busto, R, Klintmalm, GB, Somani, J, Lyon, GM, Pursell, K, Stosor, V, Muňoz, P, Limaye, AP, Kalil, AC, Pruett, TL, Garcia-Diaz, J, Humar, A, Houston, S, House, AA, Wray, D, Orloff, S, Dowdy, LA, Fisher, RA, Heitman, J, Wagener, MM & Husain, S 2008, 'Central nervous system cryptococcosis in solid organ transplant recipients: Clinical relevance of abnormal neuroimaging findings', Transplantation, vol. 86, no. 5, pp. 647-651. https://doi.org/10.1097/TP.0b013e3181814e76
Singh, Nina ; Lortholary, Olivier ; Dromer, Françoise ; Alexander, Barbara D. ; Gupta, Krishan L. ; John, George T. ; Del Busto, Ramon ; Klintmalm, Goran B. ; Somani, Jyoti ; Lyon, G. Marshall ; Pursell, Kenneth ; Stosor, Valentina ; Muňoz, 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. / Central nervous system cryptococcosis in solid organ transplant recipients : Clinical relevance of abnormal neuroimaging findings. In: Transplantation. 2008 ; Vol. 86, No. 5. pp. 647-651.
@article{4d770a9556774ce7b0fd72534f98afb7,
title = "Central nervous system cryptococcosis in solid organ transplant recipients: Clinical relevance of abnormal neuroimaging findings",
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. CONCLUSIONS.: 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.",
keywords = "C. neoformans, Central nervous system infection, Cryptococcal antigen, Cryptococcosis, Transplants",
author = "Nina Singh and Olivier Lortholary and Fran{\cc}oise Dromer and Alexander, {Barbara D.} and Gupta, {Krishan L.} and John, {George T.} and {Del Busto}, Ramon and Klintmalm, {Goran B.} and Jyoti Somani and Lyon, {G. Marshall} and Kenneth Pursell and Valentina Stosor and Patricia Muňoz and Limaye, {Ajit P.} and Kalil, {Andre C} and Pruett, {Timothy L.} and Julia Garcia-Diaz and Atul Humar and Sally Houston and House, {Andrew A.} and Dannah Wray and Susan Orloff and Dowdy, {Lorraine A.} and Fisher, {Robert A.} and Joseph Heitman and Wagener, {Marilyn M.} and Shahid Husain",
year = "2008",
month = "9",
day = "15",
doi = "10.1097/TP.0b013e3181814e76",
language = "English (US)",
volume = "86",
pages = "647--651",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Central nervous system cryptococcosis in solid organ transplant recipients

T2 - Clinical relevance of abnormal neuroimaging findings

AU - Singh, Nina

AU - Lortholary, Olivier

AU - Dromer, Françoise

AU - Alexander, Barbara D.

AU - Gupta, Krishan L.

AU - John, George T.

AU - Del Busto, Ramon

AU - Klintmalm, Goran B.

AU - Somani, Jyoti

AU - Lyon, G. Marshall

AU - Pursell, Kenneth

AU - Stosor, Valentina

AU - Muňoz, Patricia

AU - Limaye, Ajit P.

AU - Kalil, Andre C

AU - Pruett, Timothy L.

AU - Garcia-Diaz, Julia

AU - Humar, Atul

AU - Houston, Sally

AU - House, Andrew A.

AU - Wray, Dannah

AU - Orloff, Susan

AU - Dowdy, Lorraine A.

AU - Fisher, Robert A.

AU - Heitman, Joseph

AU - Wagener, Marilyn M.

AU - Husain, Shahid

PY - 2008/9/15

Y1 - 2008/9/15

N2 - 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. CONCLUSIONS.: 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.

AB - 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. CONCLUSIONS.: 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.

KW - C. neoformans

KW - Central nervous system infection

KW - Cryptococcal antigen

KW - Cryptococcosis

KW - Transplants

UR - http://www.scopus.com/inward/record.url?scp=53449096011&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=53449096011&partnerID=8YFLogxK

U2 - 10.1097/TP.0b013e3181814e76

DO - 10.1097/TP.0b013e3181814e76

M3 - Article

VL - 86

SP - 647

EP - 651

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 5

ER -