title: Cryptococcosis in kidney transplant recipients in a Chinese university hospital and a review of published cases.
abstract: BACKGROUND
  Cryptococcosis is a severe fungal infection with a high mortality rate among solid-organ transplant recipients. Today, China is among the countries performing the most kidney transplants worldwide, however data on the association of cryptococcosis with kidney transplantation in mainland China remain scarce and fragmented.
  
  
  METHODS
  We retrospectively analyzed cases of culture-confirmed cryptococcosis following kidney transplantation that have occurred at our hospital and reviewed the published cases in China over the last 30 years.
  
  
  RESULTS
  Cryptococcosis in kidney transplant recipients was mainly caused by Cryptococcus neoformans var. grubii VNI strains and occurred most frequently in patients aged 41-50 years (37.9%, 11/29). The average time to infection after kidney transplantation was 5.16 ± 3.97 years. The clinical manifestations were found to be diverse, with slight to moderate headache and fever, meningeal irritation, and high cerebrospinal fluid pressure being relatively common. Physicians should be alert to these symptoms among kidney transplant recipients.
  
  
  CONCLUSIONS
  Cryptococcosis is a serious infection among kidney transplant recipients in mainland China. It has unique characteristics, such as a relatively long time to onset after kidney transplantation, and diverse clinical manifestations. Treatment with intrathecal injection of amphotericin B is considered effective for central nervous system involvement. The findings of this study also highlight the urgent need for multicenter, prospective, and multidisciplinary clinical studies and education on cryptococcosis in kidney transplant recipients in China.
authors: Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Ya-li
authors: YL
authors: Yang
authors: Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Min
authors: M
authors: Chen
authors: Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Ju-lin
authors: JL
authors: Gu
authors: Organ Transplantation Center, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Fan-yuan
authors: FY
authors: Zhu
authors: Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Xiao-guang
authors: XG
authors: Xu
authors: Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Chao
authors: C
authors: Zhang
authors: Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Jiang-han
authors: JH
authors: Chen
authors: Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China. Electronic address: panweihua@medmail.com.cn.
authors: Wei-hua
authors: WH
authors: Pan
authors: Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China. Electronic address: liaowanqing@sohu.com.
authors: Wan-qing
authors: WQ
authors: Liao
mesh_terms: D000328:Adult; D002681:China; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D003455:Cryptococcus neoformans / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D006785:Hospitals, University; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: China; Cryptococcosis; Kidney transplant