title: Clinical spectrum of invasive cryptococcosis in liver transplant recipients receiving tacrolimus.
abstract: Invasive cryptococcal infections have been reported in 0.3-1% of the patients undergoing liver transplantation in the previous reports. In contrast, invasive cryptococcosis developed in 6% of 102 consecutive liver transplants at our institution receiving tacrolimus as primary immunosuppression. Cutaneous and/or osteoarticular infections due to cryptococcus were detected in 67% of the patients with cryptococcosis, whereas meningitis was present only in 17%. One of the six patients with cryptococcosis presented with refractory shock and multiorgan system failure attributable solely to cryptococcosis. Patients with cryptococcal infections were significantly older than all other liver transplant recipients (p = 0.017), suggesting reactivation as opposed to primary infection as pathogenesis of cryptococcosis. 100% of the patients with cryptococcosis resided on the Eastern coast of the United States as compared to 59% of the patients without cryptococcosis (p = 0.08). There was no difference in the severity of underlying liver disease, degree of immunosuppression or CMV infection or disease between patients who did and did not develop cryptococcosis. Atypical manifestations, e.g. cutaneous diseases or sepsis syndrome, as opposed to subclinical meningitis, may be a clinical feature of cryptococcal infection in liver transplant recipients.
authors.affiliation: VA Medical Center, Infectious Disease Section, Pittsburgh, PA 15240, USA.
authors.forename: N
authors.initials: N
authors.lastname: Singh
authors.forename: T
authors.initials: T
authors.lastname: Gayowski
authors.forename: M M
authors.initials: MM
authors.lastname: Wagener
authors.forename: I R
authors.initials: IR
authors.lastname: Marino
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D003453:Cryptococcosis / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus