title: Identifying predictors of central nervous system disease in solid organ transplant recipients with cryptococcosis.
abstract: BACKGROUND
  Cerebrospinal fluid (CSF) analysis is often deferred in patients with cryptococcal disease, particularly in the absence of neurologic manifestations. We sought to determine whether a subset of solid organ transplant (SOT) recipients with high likelihood of central nervous system (CNS) disease could be identified in whom CSF analysis must be performed.
  
  
  METHODS
  Patients comprised a multicenter cohort of SOT recipients with cryptococcosis.
  
  
  RESULTS
  Of 129 (88%) of 146 SOT recipients with cryptococcosis who underwent CSF analysis, 80 (62%) had CNS disease. In the overall study population, abnormal mental status, time to onset of cryptococcosis more than 24 months posttransplantation (late-onset disease), serum cryptococcal antigen titer more than 1:64, and fungemia were independently associated with an increased risk of CNS disease. Of patients with abnormal mental status, 95% had CNS cryptococcosis. When only patients with normal mental status were considered, three predictors (serum antigen titer >1:64, fungemia, and late-onset disease) independently identified patients with CNS cryptococcosis; the risk of CNS disease was 14% if none, 39% if one, and 94% if two of the aforementioned predictors existed (chi for trend P<0.001).
  
  
  CONCLUSIONS
  CSF analysis should be strongly considered in SOT recipients with cryptococcosis who have late-onset disease, fungemia, or serum cryptococcal antigen titer more than 1:64 even in the presence of normal mental status.
authors.affiliation: VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Osawa
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: Graeme N
authors.initials: GN
authors.lastname: Forrest
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.forename: Jyoti
authors.initials: J
authors.lastname: Somani
authors.forename: Krishan L
authors.initials: KL
authors.lastname: Gupta
authors.forename: Ramon
authors.initials: R
authors.lastname: Del Busto
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Costi D
authors.initials: CD
authors.lastname: Sifri
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.forename: George T
authors.initials: GT
authors.lastname: John
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pursell
authors.forename: Valentina
authors.initials: V
authors.lastname: Stosor
authors.forename: Michele I
authors.initials: MI
authors.lastname: Morris
authors.forename: Lorraine A
authors.initials: LA
authors.lastname: Dowdy
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
authors.forename: Julia
authors.initials: J
authors.lastname: Garcia-Diaz
authors.forename: Susan
authors.initials: S
authors.lastname: Orloff
authors.forename: Andrew A
authors.initials: AA
authors.lastname: House
authors.forename: Sally
authors.initials: S
authors.lastname: Houston
authors.forename: Dannah
authors.initials: D
authors.lastname: Wray
authors.forename: Shirish
authors.initials: S
authors.lastname: Huprikar
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Johnson
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
authors.forename: Raymund R
authors.initials: RR
authors.lastname: Razonable
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
mesh_terms: D000328:Adult; D000946:Antigens, Fungal / Q000097:blood; D002493:Central Nervous System Diseases / Q000453:epidemiology*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003453:Cryptococcosis / Q000150:complications / Q000453:epidemiology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D000946:Antigens, Fungal; D007166:Immunosuppressive Agents