title: Pulmonary cryptococcosis in solid organ transplant recipients: clinical relevance of serum cryptococcal antigen.
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 (P=.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.
authors.affiliation: University of Pittsburgh, Pennsylvania, USA. nis5@pitt.edu
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Françoise
authors.initials: F
authors.lastname: Dromer
authors.forename: Krishan L
authors.initials: KL
authors.lastname: Gupta
authors.forename: George T
authors.initials: GT
authors.lastname: John
authors.forename: Ramon
authors.initials: R
authors.lastname: del Busto
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
authors.forename: Jyoti
authors.initials: J
authors.lastname: Somani
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pursell
authors.forename: Valentina
authors.initials: V
authors.lastname: Stosor
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Julia
authors.initials: J
authors.lastname: Garcia-Diaz
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
authors.forename: Sally
authors.initials: S
authors.lastname: Houston
authors.forename: Andrew A
authors.initials: AA
authors.lastname: House
authors.forename: Dannah
authors.initials: D
authors.lastname: Wray
authors.forename: Susan
authors.initials: S
authors.lastname: Orloff
authors.forename: Lorraine A
authors.initials: LA
authors.lastname: Dowdy
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Joseph
authors.initials: J
authors.lastname: Heitman
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
mesh_terms: D000328:Adult; D000368:Aged; D000946:Antigens, Fungal / Q000097:blood*; D015331:Cohort Studies; D003453:Cryptococcosis / Q000097:blood / Q000276:immunology* / Q000382:microbiology; D003455:Cryptococcus neoformans / Q000276:immunology* / Q000302:isolation & purification; D005260:Female; D016469:Fungemia / Q000276:immunology / Q000382:microbiology; D006801:Humans; D016867:Immunocompromised Host; D008172:Lung Diseases, Fungal / Q000097:blood / Q000276:immunology* / Q000382:microbiology; D008297:Male; D016919:Meningitis, Cryptococcal / Q000276:immunology / Q000382:microbiology; D008875:Middle Aged; D011446:Prospective Studies; D014181:Transplantation Immunology
chemical_list: D000946:Antigens, Fungal