Antifungal management practices and evolution of infection in organ transplant recipients with cryptococcus neoformans infection.
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.
Singh
Nina
N
University of Pittsburgh Medical Center, Pittsburgh, PA 15240, USA. nis5@pitt.edu
Lortholary
Olivier
O
Alexander
Barbara D
BD
Gupta
Krishan L
KL
John
George T
GT
Pursell
Kenneth J
KJ
Muñoz
Patricia
P
Klintmalm
Goran B
GB
Stosor
Valentina
V
Del Busto
Ramon
R
Limaye
Ajit P
AP
Somani
Jyoti
J
Lyon
Marshall
M
Houston
Sally
S
House
Andrew A
AA
Pruett
Timothy L
TL
Orloff
Susan
S
Humar
Atul
A
Dowdy
Lorraine A
LA
Garcia-Diaz
Julia
J
Kalil
Andre C
AC
Fisher
Robert A
RA
Heitman
Joseph
J
Husain
Shahid
S
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
D000935:Antifungal Agents