Pulmonary cryptococcosis in solid organ transplant recipients: Clinical relevance of serum cryptococcal antigen

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

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Background. The role of serum cryptococcal antigen in the diagnosis and determinants of antigen positivity in solid organ transplant (SOT) recipients with pulmonary cryptococcosis has not been fully defined. Methods. We conducted a prospective, multicenter study of SOT recipients with pulmonary cryptococcosis during 1999-2006. Results. Forty (83%) of 48 patients with pulmonary cryptococcosis tested positive for cryptococcal antigen. Patients with concomitant extrapulmonary disease were more likely to have a positive antigen test result (P = .018), and antigen titers were higher in patients with extrapulmonary disease (P = .003) or fungemia (P = .045). Patients with single nodules were less likely to have a positive antigen test result than were those with all other radiographic presentations (P = .053). Among patients with isolated pulmonary cryptococcosis, lung transplant recipients were less likely to have positive cryptococcal antigen test results than were recipients of other types of SOT (Pp.003). In all, 38% of the patients were asymptomatic or had pulmonary cryptococcosis detected as an incidental finding. Nodular densities or mass lesions were more likely to present as asymptomatic or incidentally detected pulmonary cryptococcosis than as pleural effusions and infiltrates (P = .008). Conclusions. A positive serum cryptococcal antigen test result in SOT recipients with pulmonary cryptococcosis appears to reflect extrapulmonary or more advanced radiographic disease.

Original languageEnglish (US)
Pages (from-to)e12-e18
JournalClinical Infectious Diseases
Volume46
Issue number2
DOIs
StatePublished - Jan 15 2008

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Cryptococcosis
Transplants
Antigens
Lung
Serum
Fungemia
Incidental Findings
Transplant Recipients
Pleural Effusion
Multicenter Studies
Prospective Studies

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Singh, N., Alexander, B. D., Lortholary, O., Dromer, F., Gupta, K. L., John, G. T., ... Husain, S. (2008). Pulmonary cryptococcosis in solid organ transplant recipients: Clinical relevance of serum cryptococcal antigen. Clinical Infectious Diseases, 46(2), e12-e18. https://doi.org/10.1086/524738

Pulmonary cryptococcosis in solid organ transplant recipients : Clinical relevance of serum cryptococcal antigen. / Singh, Nina; Alexander, Barbara D.; Lortholary, Olivier; Dromer, Françoise; Gupta, Krishan L.; John, George T.; Del Busto, Ramon; Klintmalm, Goran B.; Somani, Jyoti; Lyon, G. Marshall; Pursell, Kenneth; Stosor, Valentina; Muñoz, 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: Clinical Infectious Diseases, Vol. 46, No. 2, 15.01.2008, p. e12-e18.

Research output: Contribution to journalArticle

Singh, N, Alexander, BD, Lortholary, O, Dromer, F, Gupta, KL, John, GT, Del Busto, R, Klintmalm, GB, Somani, J, Lyon, GM, Pursell, K, Stosor, V, Muñoz, 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, 'Pulmonary cryptococcosis in solid organ transplant recipients: Clinical relevance of serum cryptococcal antigen', Clinical Infectious Diseases, vol. 46, no. 2, pp. e12-e18. https://doi.org/10.1086/524738
Singh, Nina ; Alexander, Barbara D. ; Lortholary, Olivier ; Dromer, Françoise ; Gupta, Krishan L. ; John, George T. ; Del Busto, Ramon ; Klintmalm, Goran B. ; Somani, Jyoti ; Lyon, G. Marshall ; Pursell, Kenneth ; Stosor, Valentina ; Muñoz, 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. / Pulmonary cryptococcosis in solid organ transplant recipients : Clinical relevance of serum cryptococcal antigen. In: Clinical Infectious Diseases. 2008 ; Vol. 46, No. 2. pp. e12-e18.
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abstract = "Background. The role of serum cryptococcal antigen in the diagnosis and determinants of antigen positivity in solid organ transplant (SOT) recipients with pulmonary cryptococcosis has not been fully defined. Methods. We conducted a prospective, multicenter study of SOT recipients with pulmonary cryptococcosis during 1999-2006. Results. Forty (83{\%}) of 48 patients with pulmonary cryptococcosis tested positive for cryptococcal antigen. Patients with concomitant extrapulmonary disease were more likely to have a positive antigen test result (P = .018), and antigen titers were higher in patients with extrapulmonary disease (P = .003) or fungemia (P = .045). Patients with single nodules were less likely to have a positive antigen test result than were those with all other radiographic presentations (P = .053). Among patients with isolated pulmonary cryptococcosis, lung transplant recipients were less likely to have positive cryptococcal antigen test results than were recipients of other types of SOT (Pp.003). In all, 38{\%} of the patients were asymptomatic or had pulmonary cryptococcosis detected as an incidental finding. Nodular densities or mass lesions were more likely to present as asymptomatic or incidentally detected pulmonary cryptococcosis than as pleural effusions and infiltrates (P = .008). Conclusions. A positive serum cryptococcal antigen test result in SOT recipients with pulmonary cryptococcosis appears to reflect extrapulmonary or more advanced radiographic disease.",
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T1 - Pulmonary cryptococcosis in solid organ transplant recipients

T2 - Clinical relevance of serum cryptococcal antigen

AU - Singh, Nina

AU - Alexander, Barbara D.

AU - Lortholary, Olivier

AU - Dromer, Françoise

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 - Muñoz, 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

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Y1 - 2008/1/15

N2 - Background. The role of serum cryptococcal antigen in the diagnosis and determinants of antigen positivity in solid organ transplant (SOT) recipients with pulmonary cryptococcosis has not been fully defined. Methods. We conducted a prospective, multicenter study of SOT recipients with pulmonary cryptococcosis during 1999-2006. Results. Forty (83%) of 48 patients with pulmonary cryptococcosis tested positive for cryptococcal antigen. Patients with concomitant extrapulmonary disease were more likely to have a positive antigen test result (P = .018), and antigen titers were higher in patients with extrapulmonary disease (P = .003) or fungemia (P = .045). Patients with single nodules were less likely to have a positive antigen test result than were those with all other radiographic presentations (P = .053). Among patients with isolated pulmonary cryptococcosis, lung transplant recipients were less likely to have positive cryptococcal antigen test results than were recipients of other types of SOT (Pp.003). In all, 38% of the patients were asymptomatic or had pulmonary cryptococcosis detected as an incidental finding. Nodular densities or mass lesions were more likely to present as asymptomatic or incidentally detected pulmonary cryptococcosis than as pleural effusions and infiltrates (P = .008). Conclusions. A positive serum cryptococcal antigen test result in SOT recipients with pulmonary cryptococcosis appears to reflect extrapulmonary or more advanced radiographic disease.

AB - Background. The role of serum cryptococcal antigen in the diagnosis and determinants of antigen positivity in solid organ transplant (SOT) recipients with pulmonary cryptococcosis has not been fully defined. Methods. We conducted a prospective, multicenter study of SOT recipients with pulmonary cryptococcosis during 1999-2006. Results. Forty (83%) of 48 patients with pulmonary cryptococcosis tested positive for cryptococcal antigen. Patients with concomitant extrapulmonary disease were more likely to have a positive antigen test result (P = .018), and antigen titers were higher in patients with extrapulmonary disease (P = .003) or fungemia (P = .045). Patients with single nodules were less likely to have a positive antigen test result than were those with all other radiographic presentations (P = .053). Among patients with isolated pulmonary cryptococcosis, lung transplant recipients were less likely to have positive cryptococcal antigen test results than were recipients of other types of SOT (Pp.003). In all, 38% of the patients were asymptomatic or had pulmonary cryptococcosis detected as an incidental finding. Nodular densities or mass lesions were more likely to present as asymptomatic or incidentally detected pulmonary cryptococcosis than as pleural effusions and infiltrates (P = .008). Conclusions. A positive serum cryptococcal antigen test result in SOT recipients with pulmonary cryptococcosis appears to reflect extrapulmonary or more advanced radiographic disease.

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