Pulmonary cryptococcosis in solid organ transplant recipients: Clinical relevance of serum cryptococcal antigen

• Type of Material: Article
• Authors: Nina Alexander, Duke University; Barbara D. Lortholary, Hôpital Necker-Enfants malades; Oliver Dromer, Hôpital Necker-Enfants malades; Francoise Gupta, Postgraduate Institute of Medical Education and Research; Krishan L. John, Christian Medical College Hospital; George T. del Busto, Henry Ford Hospital; Ramon Klintmalm, Baylor University; Goran B. Somani, Emory University; Jyoti Lyon III, Emory University; Nina Singh, University of Pittsburgh; Kenneth Pursell, University of Chicago; Valentina Stosor, Northwestern University; Patricia Munoz, Hospital General Universitario Gregorio Maraňón; Ajit P. Limaye, University of Washington; Andre C. Kalil, University of Nebraska; Timothy L. Pruett, University of Virginia; Julia Garcia-Diaz, Ochsner Clinic; Atul Humar, Toronto General Hospital; Sally Houston, University of South Florida
• Language: English
• Date: 2008-01-15
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option C
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2007 by the Infectious Diseases Society of America. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1086/524738
• Title of Journal or Parent Work: Clinical Infectious Diseases
• ISSN: 1058-4838
• Volume: 46
• Issue: 2
• Start Page: E12
• End Page: E18
• Grant/Funding Information: Supported by NIH/NIAID award R01 AI 054719-01 to NS.
• Keywords: ERA; THERAPY; FUNGAL-INFECTIONS; NEOFORMANS INFECTION; AIDS; Microbiology; Immunology; EPIDEMIOLOGY; Life Sciences & Biomedicine; Infectious Diseases; CEREBROSPINAL-FLUID; MENINGITIS; LUNG; Science & Technology
• Research Categories: Biology, Microbiology; Health Sciences, Medicine and Surgery

Abstract

Background: The role of serum cryptococcal antigen in the diagnosis and determinants of antigen positivity in solid organ transplant (SOT) recipients with pulmonary cryptococcosis has not been fully defined. Methods: We conducted a prospective, multicenter study of SOT recipients with pulmonary cryptococcosis during 1999-2006. Results: Forty (83%) of 48 patients with pulmonary cryptococcosis tested positive for cryptococcal antigen. Patients with concomitant extrapulmonary disease were more likely to have a positive antigen test result (P = .018), and antigen titers were higher in patients with extrapulmonary disease (P = .003) or fungemia (P = .045). Patients with single nodules were less likely to have a positive antigen test result than were those with all other radiographic presentations (P = .053). Among patients with isolated pulmonary cryptococcosis, lung transplant recipients were less likely to have positive cryptococcal antigen test results than were recipients of other types of SOT (Pp.003). In all, 38% of the patients were asymptomatic or had pulmonary cryptococcosis detected as an incidental finding. Nodular densities or mass lesions were more likely to present as asymptomatic or incidentally detected pulmonary cryptococcosis than as pleural effusions and infiltrates (P = .008). Conclusions: A positive serum cryptococcal antigen test result in SOT recipients with pulmonary cryptococcosis appears to reflect extrapulmonary or more advanced radiographic disease.