Cutaneous cryptococcosis in solid organ transplant recipients

Hsin Yun Sun, Barbara D. Alexander, Olivier Lortholary, Francoise Dromer, Graeme N. Forrest, G. Marshall Lyon, Jyoti Somani, Krishan L. Gupta, Ramon Del Busto, Timothy L. Pruett, Costi D. Sifri, Ajit P. Limaye, George T. John, Goran B. Klintmalm, Kenneth Pursell, Valentina Stosor, Michele I. Morris, Lorraine A. Dowdy, Patricia Muoz, Andre C. Kalil & 13 others Julia Garcia-Diaz, Susan Orloff, Andrew A. House, Sally H. Houston, Dannah Wray, Shirish Huprikar, Leonard B. Johnson, Atul Humar, Raymund R. Razonable, Robert A. Fisher, Shahid Husain, Marilyn M. Wagener, Nina Singh

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Clinical manifestations, treatment, and outcomes of cutaneous cryptococcosis in solid organ transplant (SOT) recipients are not fully defined. In a prospective cohort comprising 146 SOT recipients with cryptococcosis, we describe the presentation, antifungal therapy, and outcome of cutaneous cryptococcal disease. Cutaneous cryptococcosis was documented in 26/146 (17.8%) of the patients and manifested as nodular/mass (34.8%), maculopapule (30.4%), ulcer/pustule/abscess (30.4%), and cellulitis (30.4%) with 65.2% of the skin lesions occurred in the lower extremities. Localized disease developed in 30.8% (8/26), and disseminated disease in 69.2% (18/26) with involvement of the central nervous system (88.9%, 16/18), lung (33.3%, 6/18), or fungemia (55.6%, 10/18). Fluconazole (37.5%) was employed most often for localized and lipid formulations of amphotericin B (61.1%) for disseminated disease. Overall mortality at 90 days was 15.4% (4/26) with 16.7% in disseminated and 12.5% in localized disease (P 0.78). SOT recipients who died were more likely to have renal failure (75.0% vs. 13.6%, P 0.028), longer time to onset of disease after transplantation (87.5 vs. 22.6 months, P 0.023), and abnormal mental status (75% vs. 13.6%, P 0.028) than those who survived. Cutaneous cryptococcosis represents disseminated disease in most SOT recipients and preferentially involves the extremities. Outcomes with appropriate management were comparable between SOT recipients with localized and disseminated cryptococcosis.

Original languageEnglish (US)
Pages (from-to)785-791
Number of pages7
JournalMedical Mycology
Volume48
Issue number6
DOIs
StatePublished - Sep 2010

Fingerprint

organ transplantation
Cryptococcosis
Transplants
Skin
cellulitis
fluconazole
Fungemia
amphotericin B
abscess
renal failure
skin lesions
Cellulitis
Fluconazole
central nervous system
Amphotericin B
Skin Diseases
Abscess
Ulcer
lungs
Renal Insufficiency

Keywords

  • Cryptococcus
  • Fungal infections
  • Transplants

ASJC Scopus subject areas

  • veterinary(all)
  • Infectious Diseases

Cite this

Sun, H. Y., Alexander, B. D., Lortholary, O., Dromer, F., Forrest, G. N., Lyon, G. M., ... Singh, N. (2010). Cutaneous cryptococcosis in solid organ transplant recipients. Medical Mycology, 48(6), 785-791. https://doi.org/10.3109/13693780903496617

Cutaneous cryptococcosis in solid organ transplant recipients. / Sun, Hsin Yun; Alexander, Barbara D.; Lortholary, Olivier; Dromer, Francoise; Forrest, Graeme N.; Lyon, G. Marshall; Somani, Jyoti; Gupta, Krishan L.; Busto, Ramon Del; Pruett, Timothy L.; Sifri, Costi D.; Limaye, Ajit P.; John, George T.; Klintmalm, Goran B.; Pursell, Kenneth; Stosor, Valentina; Morris, Michele I.; Dowdy, Lorraine A.; Muoz, Patricia; Kalil, Andre C.; Garcia-Diaz, Julia; Orloff, Susan; House, Andrew A.; Houston, Sally H.; Wray, Dannah; Huprikar, Shirish; Johnson, Leonard B.; Humar, Atul; Razonable, Raymund R.; Fisher, Robert A.; Husain, Shahid; Wagener, Marilyn M.; Singh, Nina.

In: Medical Mycology, Vol. 48, No. 6, 09.2010, p. 785-791.

Research output: Contribution to journalArticle

Sun, HY, Alexander, BD, Lortholary, O, Dromer, F, Forrest, GN, Lyon, GM, Somani, J, Gupta, KL, Busto, RD, Pruett, TL, Sifri, CD, Limaye, AP, John, GT, Klintmalm, GB, Pursell, K, Stosor, V, Morris, MI, Dowdy, LA, Muoz, P, Kalil, AC, Garcia-Diaz, J, Orloff, S, House, AA, Houston, SH, Wray, D, Huprikar, S, Johnson, LB, Humar, A, Razonable, RR, Fisher, RA, Husain, S, Wagener, MM & Singh, N 2010, 'Cutaneous cryptococcosis in solid organ transplant recipients', Medical Mycology, vol. 48, no. 6, pp. 785-791. https://doi.org/10.3109/13693780903496617
Sun HY, Alexander BD, Lortholary O, Dromer F, Forrest GN, Lyon GM et al. Cutaneous cryptococcosis in solid organ transplant recipients. Medical Mycology. 2010 Sep;48(6):785-791. https://doi.org/10.3109/13693780903496617
Sun, Hsin Yun ; Alexander, Barbara D. ; Lortholary, Olivier ; Dromer, Francoise ; Forrest, Graeme N. ; Lyon, G. Marshall ; Somani, Jyoti ; Gupta, Krishan L. ; Busto, Ramon Del ; Pruett, Timothy L. ; Sifri, Costi D. ; Limaye, Ajit P. ; John, George T. ; Klintmalm, Goran B. ; Pursell, Kenneth ; Stosor, Valentina ; Morris, Michele I. ; Dowdy, Lorraine A. ; Muoz, Patricia ; Kalil, Andre C. ; Garcia-Diaz, Julia ; Orloff, Susan ; House, Andrew A. ; Houston, Sally H. ; Wray, Dannah ; Huprikar, Shirish ; Johnson, Leonard B. ; Humar, Atul ; Razonable, Raymund R. ; Fisher, Robert A. ; Husain, Shahid ; Wagener, Marilyn M. ; Singh, Nina. / Cutaneous cryptococcosis in solid organ transplant recipients. In: Medical Mycology. 2010 ; Vol. 48, No. 6. pp. 785-791.
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