Antifungal management practices and evolution of infection in organ transplant recipients with cryptococcus neoformans infection.

Published

Journal Article

BACKGROUND: Therapeutic practices for Cryptococcus neoformans infection in transplant recipients vary, particularly with regards to antifungal agent employed, and duration of therapy. The risk of relapse and time to recurrence is not known. We assessed antifungal treatment practices for cryptococcosis in a cohort of prospectively followed organ transplant recipients. METHODS: The patients comprised 83 transplant recipients with cryptococcosis followed for a median of 2.1 and up to 5.2 years. RESULTS: Patients with central nervous system infection (69% vs. 16%, P = 0.00001), disseminated infection (82.7% vs. 20%, P = 0.00001), and fungemia (29% vs. 8%, P = 0.046) were more likely to receive regimens containing amphotericin B than fluconazole as primary therapy. The use of fluconazole, on the other hand, was more likely for infection limited to the lungs (64% vs. 14%, P = 0.00002). Survival at 6 months tended to be lower in patients whose CSF cultures at 2 weeks were positive compared to those whose CSF cultures were negative (50% vs. 91%, P = 0.06). Maintenance therapy was employed in 68% (54/79) of the patients who survived >3 weeks. The median duration of maintenance therapy was 183 days; 55% received maintenance for > or = 6 months and 25% for >1 year. Relapse was documented in 1.3% (1/79) of the patients. CONCLUSIONS: A majority of the organ transplant recipients with cryptococcosis receive maintenance antifungal therapy for 6 months with low risk of relapse. These data can assist in trials to assess the optimal therapeutic approach and duration of therapy for cryptococcosis in transplant recipients.

Full Text

Duke Authors

Cited Authors

  • Singh, N; Lortholary, O; Alexander, BD; Gupta, KL; John, GT; Pursell, KJ; Muñoz, P; Klintmalm, GB; Stosor, V; Del Busto, R; Limaye, AP; Somani, J; Lyon, M; Houston, S; House, AA; Pruett, TL; Orloff, S; Humar, A; Dowdy, LA; Garcia-Diaz, J; Kalil, AC; Fisher, RA; Heitman, J; Husain, S

Published Date

  • October 27, 2005

Published In

Volume / Issue

  • 80 / 8

Start / End Page

  • 1033 - 1039

PubMed ID

  • 16278582

Pubmed Central ID

  • 16278582

International Standard Serial Number (ISSN)

  • 0041-1337

Digital Object Identifier (DOI)

  • 10.1097/01.tp.0000173774.74388.49

Language

  • eng

Conference Location

  • United States