Abstract | BACKGROUND: 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 > or = 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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Authors | 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, Andre C Kalil, Robert A Fisher, Joseph Heitman, Shahid Husain |
Journal | Transplantation
(Transplantation)
Vol. 80
Issue 8
Pg. 1033-9
(Oct 27 2005)
ISSN: 0041-1337 [Print] United States |
PMID | 16278582
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Chemical References |
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Topics |
- Adult
- Aged
- Antifungal Agents
(therapeutic use)
- Cryptococcosis
(drug therapy)
- Cryptococcus neoformans
- Female
- Humans
- Male
- Middle Aged
- Opportunistic Infections
(drug therapy)
- Organ Transplantation
- Treatment Outcome
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