Central nervous system cryptococcosis in solid organ transplant recipients: clinical relevance of abnormal neuroimaging findings.
BACKGROUND
Prognostic implications of cryptococcal antigen and outcomes associated with central nervous system (CNS) cryptococcal lesions in solid organ transplant recipients have not been fully defined.


METHODS
Patients were derived form a cohort of 122 solid organ transplant recipients with cryptococcosis in a multicenter study from 1999 to 2006.


RESULTS
Central nervous system cryptococcosis was documented in 61 patients. Serum or cerebral spinal fluid antigen titers did not correlate with mortality at 90 days or cerebral spinal fluid sterilization at 2 weeks. Central nervous system lesions were identified in 16 patients and included leptomeningeal lesions in eight, parenchymal lesions in six, and hydrocephalus in two. Overall, 13/16 CNS lesions were present at the time of diagnosis. One parenchymal and two hydrocephalus lesions, however, developed after diagnosis and fulfilled the criteria for immune reconstitution syndrome. Cerebral spinal fluid antigen titers were higher with meningeal versus parenchymal lesions, and hydrocephalus (P=0.015). Mortality was 50% (3/6) for patients with parenchymal, 12.5% (1/8) for those with leptomeningeal, and 0/3 for patients with hydrocephalus. Mortality was 31% (4/13) for patients with CNS lesions at baseline and 0/3 in those with new onset lesions.


CONCLUSIONS
Despite a higher antigen titer with meningeal lesions, outcomes tended to be worse with parenchymal compared with meningeal lesions or hydrocephalus. New onset CNS lesions may represent immune reconstitution syndrome and seemed to be associated with better outcome.
Singh
Nina
N
University of Pittsburgh, Pittsburgh, PA, USA. nis5@pitt.edu
Lortholary
Olivier
O
Dromer
Françoise
F
Alexander
Barbara D
BD
Gupta
Krishan L
KL
John
George T
GT
del Busto
Ramon
R
Klintmalm
Goran B
GB
Somani
Jyoti
J
Lyon
G Marshall
GM
Pursell
Kenneth
K
Stosor
Valentina
V
Munoz
Patricia
P
Limaye
Ajit P
AP
Kalil
Andre C
AC
Pruett
Timothy L
TL
Garcia-Diaz
Julia
J
Humar
Atul
A
Houston
Sally
S
House
Andrew A
AA
Wray
Dannah
D
Orloff
Susan
S
Dowdy
Lorraine A
LA
Fisher
Robert A
RA
Heitman
Joseph
J
Wagener
Marilyn M
MM
Husain
Shahid
S
D000328:Adult; D000368:Aged; D002555:Cerebrospinal Fluid / Q000382:microbiology; D003454:Cryptococcus / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000453:epidemiology*; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000382:microbiology*; D011379:Prognosis; D012189:Retrospective Studies
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