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Identifying predictors of central nervous system disease in solid organ transplant recipients with cryptococcosis.

Publication ,  Journal Article
Osawa, R; Alexander, BD; Lortholary, O; Dromer, F; Forrest, GN; Lyon, GM; Somani, J; Gupta, KL; Del Busto, R; Pruett, TL; Sifri, CD; John, GT ...
Published in: Transplantation
January 15, 2010

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.

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Published In

Transplantation

DOI

EISSN

1534-6080

Publication Date

January 15, 2010

Volume

89

Issue

1

Start / End Page

69 / 74

Location

United States

Related Subject Headings

  • Surgery
  • Regression Analysis
  • Prospective Studies
  • Predictive Value of Tests
  • Postoperative Complications
  • Organ Transplantation
  • Middle Aged
  • Male
  • Likelihood Functions
  • Immunosuppressive Agents
 

Citation

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Osawa, R., Alexander, B. D., Lortholary, O., Dromer, F., Forrest, G. N., Lyon, G. M., … Singh, N. (2010). Identifying predictors of central nervous system disease in solid organ transplant recipients with cryptococcosis. Transplantation, 89(1), 69–74. https://doi.org/10.1097/TP.0b013e3181bcda41
Osawa, Ryosuke, Barbara D. Alexander, Olivier Lortholary, Françoise Dromer, Graeme N. Forrest, G Marshall Lyon, Jyoti Somani, et al. “Identifying predictors of central nervous system disease in solid organ transplant recipients with cryptococcosis.Transplantation 89, no. 1 (January 15, 2010): 69–74. https://doi.org/10.1097/TP.0b013e3181bcda41.
Osawa R, Alexander BD, Lortholary O, Dromer F, Forrest GN, Lyon GM, et al. Identifying predictors of central nervous system disease in solid organ transplant recipients with cryptococcosis. Transplantation. 2010 Jan 15;89(1):69–74.
Osawa, Ryosuke, et al. “Identifying predictors of central nervous system disease in solid organ transplant recipients with cryptococcosis.Transplantation, vol. 89, no. 1, Jan. 2010, pp. 69–74. Pubmed, doi:10.1097/TP.0b013e3181bcda41.
Osawa R, Alexander BD, Lortholary O, Dromer F, Forrest GN, Lyon GM, Somani J, Gupta KL, Del Busto R, Pruett TL, Sifri CD, Limaye AP, John GT, Klintmalm GB, Pursell K, Stosor V, Morris MI, Dowdy LA, Muñoz P, Kalil AC, Garcia-Diaz J, Orloff S, House AA, Houston S, Wray D, Huprikar S, Johnson LB, Humar A, Razonable RR, Fisher RA, Husain S, Wagener MM, Singh N. Identifying predictors of central nervous system disease in solid organ transplant recipients with cryptococcosis. Transplantation. 2010 Jan 15;89(1):69–74.

Published In

Transplantation

DOI

EISSN

1534-6080

Publication Date

January 15, 2010

Volume

89

Issue

1

Start / End Page

69 / 74

Location

United States

Related Subject Headings

  • Surgery
  • Regression Analysis
  • Prospective Studies
  • Predictive Value of Tests
  • Postoperative Complications
  • Organ Transplantation
  • Middle Aged
  • Male
  • Likelihood Functions
  • Immunosuppressive Agents