title: Central nervous system cryptococcosis in solid organ transplant recipients: clinical relevance of abnormal neuroimaging findings.
abstract: 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.
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA. nis5@pitt.edu
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Françoise
authors.initials: F
authors.lastname: Dromer
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: 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: Munoz
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; 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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