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

Nina Singh, Olivier Lortholary, Barbara D. Alexander, Krishan L. Gupta, George T. John, Kenneth J. Pursell, Patricia Muñoz, Goran B. Klintmalm, Valentina Stosor, Ramon Del Busto, Ajit P. Limaye, Jyoti Somani, Marshall Lyon, Sally Houston, Andrew A. House, Timothy L. Pruett, Susan Orloff, Atul Humar, Lorraine A. Dowdy, Julia Garcia-Diaz & 4 others Andre C. Kalil, Robert A. Fisher, Joseph Heitman, Shahid Husain

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

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 ≥ 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.

Original languageEnglish (US)
Pages (from-to)1033-1039
Number of pages7
JournalTransplantation
Volume80
Issue number8
DOIs
StatePublished - Oct 27 2005

Fingerprint

Cryptococcus neoformans
Practice Management
Transplants
Cryptococcosis
Infection
Recurrence
Therapeutics
Fluconazole
Maintenance
Fungemia
Transplant Recipients
Central Nervous System Infections
Antifungal Agents
Amphotericin B
Lung
Survival

Keywords

  • Cryptococcus
  • Fungal infection
  • Transplant

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Singh, N., Lortholary, O., Alexander, B. D., Gupta, K. L., John, G. T., Pursell, K. J., ... Husain, S. (2005). Antifungal management practices and evolution of infection in organ transplant recipients with Cryptococcus neoformans infection. Transplantation, 80(8), 1033-1039. https://doi.org/10.1097/01.tp.0000173774.74388.49

Antifungal management practices and evolution of infection in organ transplant recipients with Cryptococcus neoformans infection. / Singh, Nina; Lortholary, Olivier; Alexander, Barbara D.; Gupta, Krishan L.; John, George T.; Pursell, Kenneth J.; Muñoz, Patricia; Klintmalm, Goran B.; Stosor, Valentina; Busto, Ramon Del; Limaye, Ajit P.; Somani, Jyoti; Lyon, Marshall; Houston, Sally; House, Andrew A.; Pruett, Timothy L.; Orloff, Susan; Humar, Atul; Dowdy, Lorraine A.; Garcia-Diaz, Julia; Kalil, Andre C.; Fisher, Robert A.; Heitman, Joseph; Husain, Shahid.

In: Transplantation, Vol. 80, No. 8, 27.10.2005, p. 1033-1039.

Research output: Contribution to journalArticle

Singh, N, Lortholary, O, Alexander, BD, Gupta, KL, John, GT, Pursell, KJ, Muñoz, P, Klintmalm, GB, Stosor, V, Busto, RD, 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 2005, 'Antifungal management practices and evolution of infection in organ transplant recipients with Cryptococcus neoformans infection', Transplantation, vol. 80, no. 8, pp. 1033-1039. https://doi.org/10.1097/01.tp.0000173774.74388.49
Singh, Nina ; Lortholary, Olivier ; Alexander, Barbara D. ; Gupta, Krishan L. ; John, George T. ; Pursell, Kenneth J. ; Muñoz, Patricia ; Klintmalm, Goran B. ; Stosor, Valentina ; Busto, Ramon Del ; Limaye, Ajit P. ; Somani, Jyoti ; Lyon, Marshall ; Houston, Sally ; House, Andrew A. ; Pruett, Timothy L. ; Orloff, Susan ; Humar, Atul ; Dowdy, Lorraine A. ; Garcia-Diaz, Julia ; Kalil, Andre C. ; Fisher, Robert A. ; Heitman, Joseph ; Husain, Shahid. / Antifungal management practices and evolution of infection in organ transplant recipients with Cryptococcus neoformans infection. In: Transplantation. 2005 ; Vol. 80, No. 8. pp. 1033-1039.
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abstract = "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 ≥ 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.",
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T1 - Antifungal management practices and evolution of infection in organ transplant recipients with Cryptococcus neoformans infection

AU - Singh, Nina

AU - Lortholary, Olivier

AU - Alexander, Barbara D.

AU - Gupta, Krishan L.

AU - John, George T.

AU - Pursell, Kenneth J.

AU - Muñoz, Patricia

AU - Klintmalm, Goran B.

AU - Stosor, Valentina

AU - Busto, Ramon Del

AU - Limaye, Ajit P.

AU - Somani, Jyoti

AU - Lyon, Marshall

AU - Houston, Sally

AU - House, Andrew A.

AU - Pruett, Timothy L.

AU - Orloff, Susan

AU - Humar, Atul

AU - Dowdy, Lorraine A.

AU - Garcia-Diaz, Julia

AU - Kalil, Andre C.

AU - Fisher, Robert A.

AU - Heitman, Joseph

AU - Husain, Shahid

PY - 2005/10/27

Y1 - 2005/10/27

N2 - 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 ≥ 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.

AB - 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 ≥ 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.

KW - Cryptococcus

KW - Fungal infection

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