title: Antifungal management practices and evolution of infection in organ transplant recipients with cryptococcus neoformans infection.
abstract: BACKGROUND
  Therapeutic practices for Cryptococcus neoformans infection in transplant recipients vary, particularly with regards to antifungal agent employed, and duration of therapy. The risk of relapse and time to recurrence is not known. We assessed antifungal treatment practices for cryptococcosis in a cohort of prospectively followed organ transplant recipients.
  
  
  METHODS
  The patients comprised 83 transplant recipients with cryptococcosis followed for a median of 2.1 and up to 5.2 years.
  
  
  RESULTS
  Patients with central nervous system infection (69% vs. 16%, P = 0.00001), disseminated infection (82.7% vs. 20%, P = 0.00001), and fungemia (29% vs. 8%, P = 0.046) were more likely to receive regimens containing amphotericin B than fluconazole as primary therapy. The use of fluconazole, on the other hand, was more likely for infection limited to the lungs (64% vs. 14%, P = 0.00002). Survival at 6 months tended to be lower in patients whose CSF cultures at 2 weeks were positive compared to those whose CSF cultures were negative (50% vs. 91%, P = 0.06). Maintenance therapy was employed in 68% (54/79) of the patients who survived >3 weeks. The median duration of maintenance therapy was 183 days; 55% received maintenance for > or = 6 months and 25% for >1 year. Relapse was documented in 1.3% (1/79) of the patients.
  
  
  CONCLUSIONS
  A majority of the organ transplant recipients with cryptococcosis receive maintenance antifungal therapy for 6 months with low risk of relapse. These data can assist in trials to assess the optimal therapeutic approach and duration of therapy for cryptococcosis in transplant recipients.
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA 15240, USA. nis5@pitt.edu
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
authors.forename: Krishan L
authors.initials: KL
authors.lastname: Gupta
authors.forename: George T
authors.initials: GT
authors.lastname: John
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Pursell
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
authors.forename: Valentina
authors.initials: V
authors.lastname: Stosor
authors.forename: Ramon
authors.initials: R
authors.lastname: Del Busto
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.forename: Jyoti
authors.initials: J
authors.lastname: Somani
authors.forename: Marshall
authors.initials: M
authors.lastname: Lyon
authors.forename: Sally
authors.initials: S
authors.lastname: Houston
authors.forename: Andrew A
authors.initials: AA
authors.lastname: House
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Susan
authors.initials: S
authors.lastname: Orloff
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
authors.forename: Lorraine A
authors.initials: LA
authors.lastname: Dowdy
authors.forename: Julia
authors.initials: J
authors.lastname: Garcia-Diaz
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Joseph
authors.initials: J
authors.lastname: Heitman
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D003453:Cryptococcosis / Q000188:drug therapy*; D003455:Cryptococcus neoformans; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000188:drug therapy*; D016377:Organ Transplantation; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents