An immune reconstitution syndrome-like illness associated with Cryptococcus neoformans infection in organ transplant recipients.

Abstract

BACKGROUND:

We describe an immune reconstitution syndrome (IRS)-like entity in the course of evolution of Cryptococcus neoformans infection in organ transplant recipients.

METHODS:

The study population comprised a cohort of 83 consecutive organ transplant recipients with cryptococcosis who were observed for a median of 2 years in an international, multicenter study.

RESULTS:

In 4 (4.8%) of the 83 patients, an IRS-like entity was observed a median of 5.5 weeks after the initiation of appropriate antifungal therapy. Worsening of clinical manifestations was documented, despite cultures being negative for C. neoformans. These patients were significantly more likely to have received tacrolimus, mycophenolate mofetil, and prednisone as the regimen of immunosuppressive therapy than were all other patients (P = .007). The proposed basis of this phenomenon is reversal of a predominantly Th2 response at the onset of infection to a Th1 proinflammatory response as a result of receipt of effective antifungal therapy and a reduction in or cessation of immunosuppressive therapy.

CONCLUSIONS:

This study demonstrated that an IRS-like entity occurs in organ transplant recipients with C. neoformans infection. Furthermore, this entity may be misconstrued as a failure of therapy. Immunomodulatory agents may have a role as adjunctive therapy in such cases.

• Authors: Nina Singh, Olivier Lortholary, Barbara D Alexander, Krishan L Gupta, George T John, Kenneth Pursell, Patricia Munoz, 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 Dowdy, Julia Garcia-Diaz, Andre C Kalil, Robert A Fisher, Shahid Husain, Cryptococcal Collaborative Transplant Study Group
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 40 Issue 12 Pg. 1756-61 (Jun 15 2005) ISSN: 1537-6591 [Electronic] United States
• PMID: 15909263 (Publication Type: Case Reports, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antifungal Agents
• Immunosuppressive Agents
• Mycophenolic Acid
• Prednisone
• Tacrolimus

Topics

• Adult
• Aged
• Antifungal Agents (therapeutic use)
• Cohort Studies
• Cryptococcosis (drug therapy, etiology)
• Female
• Humans
• Immune System Diseases (etiology)
• Immunosuppressive Agents (adverse effects)
• Male
• Middle Aged
• Mycophenolic Acid (adverse effects, analogs & derivatives)
• Organ Transplantation (adverse effects)
• Prednisone (adverse effects)
• Tacrolimus (adverse effects)