Central nervous system cryptococcosis in solid organ transplant recipients: clinical relevance of abnormal neuroimaging findings.
Central nervous system cryptococcosis in solid organ transplant recipients: clinical relevance of abnormal neuroimaging findings.
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DOI：
10.1097/tp.0b013e3181814e76
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发表时间：
2008-09-15
期刊：
影响因子：
6.2
通讯作者：
Cryptococcal Collaborative Transplant Study Group
中科院分区：
文献类型：
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作者：
Singh N;Lortholary O;Dromer F;Alexander BD;Gupta KL;John GT;del Busto R;Klintmalm GB;Somani J;Lyon GM;Pursell K;Stosor V;Munoz P;Limaye AP;Kalil AC;Pruett TL;Garcia-Diaz J;Humar A;Houston S;House AA;Wray D;Orloff S;Dowdy LA;Fisher RA;Heitman J;Wagener MM;Husain S;Cryptococcal Collaborative Transplant Study Group
Prognostic implications of cryptococcal antigen and outcomes associated with CNS cryptococcal lesions in solid organ transplant (SOT) recipients have not been fully defined. Patients were derived form a cohort of 122 SOT recipients with cryptococcosis in a multicenter study from 1999–2006. CNS cryptococcosis was documented in 61 patients. Serum or CSF antigen titers did not correlate with mortality at 90 days or CSF sterilization at 2 weeks. CNS lesions were identified in 16 patients and included leptomeningeal lesions in 8, parenchymal lesions in 6 and hydrocephalus in 2. Overall, 13/16 CNS lesions were present at the time of diagnosis. One parenchymal and 2 hydrocephalus lesions however, developed after diagnosis and fulfilled the criteria for immune reconstitution syndrome (IRS). CSF antigen titers were higher with meningeal vs. parenchymal lesions, and hydrocephalus (p=0.015). Mortality was 50% (3/6) for patients with parenchymal, 12.5% (1/8) for those with leptomeningeal, and 0/3 for patients with hydrocephalus. Mortality was 31% (4/13) for patients with CNS lesions at baseline and 0/3 in those with new onset lesions. Despite a greater antigen titer with meningeal lesions, outcomes tended to be worse with parenchymal compared to meningeal lesions or hydrocephalus. New onset CNS lesions may represent IRS and appeared to be associated with better outcome.
