title: Geographic differences in disease expression of cryptococcosis in solid organ transplant recipients in the United States.
abstract: BACKGROUND
  Whether there are geographic differences in clinical presentation of cryptococcosis in solid organ transplant (SOT) recipients in the United States (US) is not known.
  
  
  METHODS
  Patients comprised a cohort of 120 SOT recipients from US transplant centers who fulfilled the EORTC/MSG criteria for cryptococcal disease.
  
  
  RESULTS
  Central nervous system, pulmonary, and cutaneous cryptococcal disease were observed in 51% (61/120), 64% (77/120), and 15% (18/120) of the patients, respectively. Cutaneous disease was documented in 9% (3/32) of the patients from South Atlantic region, 19% (6/32) from Mid Atlantic, 26% (6/23) from Southern, 7% (2/29) from Midwestern, and in 1 of 4 patients from the Northwestern region of the US. When controlled for age, immunosuppressive regimen, type of transplant, and renal failure at baseline, patients from the Southern compared with other regions of the US were significantly more likely to have cutaneous cryptococcal disease (OR 3.8, 95% CI 1.1-14, P=0.045).
  
  
  CONCLUSIONS
  Post-transplant cryptococcosis is more likely to present with cutaneous disease in the Southern region compared with other regions in the US. This predilection for cutaneous cryptococcosis could not be explained on the basis of differences in immunosuppression or the type of transplant. Whether our findings are related to strain-related variations in characteristics of the yeast or other transplant variables remains to be determined.
authors.affiliation: University of Buffalo, State University of New York, Buffalo, NY, U.S.A.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Osawa
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
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: 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: 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: Andre C
authors.initials: AC
authors.lastname: Kalil
authors.forename: Julia
authors.initials: J
authors.lastname: Garcia-Diaz
authors.forename: Susan L
authors.initials: SL
authors.lastname: Orloff
authors.forename: Sally H
authors.initials: SH
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: Raymund R
authors.initials: RR
authors.lastname: Razonable
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
mesh_terms: D002980:Climate; D015331:Cohort Studies; D003453:Cryptococcosis / Q000175:diagnosis*; D003881:Dermatomycoses / Q000175:diagnosis*; D005260:Female; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D014481:United States