title: A pseudo-outbreak of disseminated cryptococcal disease after orthotopic heart transplantation.
abstract: Cryptococcal infection is the third most common invasive fungal infection (IFI) among solid-organ transplant (SOT) recipients and is considered an important opportunistic infection due to its significant morbidity and mortality. To determine whether a cluster of cryptococcosis in heart transplant patients was of nosocomial nature, three cases of orthotopic heart transplant recipients with postoperative disseminated cryptococcal infection were investigated and paired with an environmental survey in a tertiary care hospital. The infection prevention department conducted a multidisciplinary investigation, which did not demonstrate any evidence of health care-associated environmental exposure. Moreover, multilocus sequence typing showed that one isolate was unique and the two others, although identical, were not temporally related and belong to the most common type seen in the Southern US. Additionally, all three patients had preexisting abnormalities of the CT chest scan and various degrees of acute and chronic rejection. Reactivation was suggested in all three patients. Screening methods may be useful to identify at risk patients and trigger a prophylactic or preemptive approach. However, more data is needed.
authors.affiliation: Infection Prevention Department, Memorial Hermann Texas Medical Center, Houston, TX, USA.
authors.forename: E
authors.initials: E
authors.lastname: Kennedy
authors.affiliation: Division of Infectious Diseases, UT Health Medical School at Houston, Houston, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Vanichanan
authors.affiliation: Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.|Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA.
authors.forename: I
authors.initials: I
authors.lastname: Rajapreyar
authors.affiliation: Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA.
authors.forename: B
authors.initials: B
authors.lastname: Gonzalez
authors.affiliation: Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.|Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA.
authors.forename: S
authors.initials: S
authors.lastname: Nathan
authors.affiliation: Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.|Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA.
authors.forename: I
authors.initials: I
authors.lastname: Gregoric
authors.affiliation: Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.|Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA.
authors.forename: B
authors.initials: B
authors.lastname: Kar
authors.affiliation: Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.|Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA.
authors.forename: P
authors.initials: P
authors.lastname: Loyalka
authors.affiliation: Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA.
authors.forename: P
authors.initials: P
authors.lastname: Weeks
authors.affiliation: Department of Pathology, UT Health Medical School at Houston, Houston, TX, USA.
authors.forename: V
authors.initials: V
authors.lastname: Chavez
authors.affiliation: Department of Pathology, UT Health Medical School at Houston, Houston, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Wanger
authors.affiliation: Infection Prevention Department, Memorial Hermann Texas Medical Center, Houston, TX, USA.|Division of Infectious Diseases, UT Health Medical School at Houston, Houston, TX, USA.
authors.forename: L
authors.initials: L
authors.lastname: Ostrosky Zeichner
mesh_terms: D000368:Aged; D002487:Centers for Disease Control and Prevention, U.S.; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000517:prevention & control; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Cryptococcosis; heart transplant; pseudo outbreak