Cryptococcosis in kidney transplant recipients in a Chinese university hospital and a review of published cases.

Abstract

BACKGROUND:

Cryptococcosis is a severe fungal infection with a high mortality rate among solid-organ transplant recipients. Today, China is among the countries performing the most kidney transplants worldwide, however data on the association of cryptococcosis with kidney transplantation in mainland China remain scarce and fragmented.

METHODS:

We retrospectively analyzed cases of culture-confirmed cryptococcosis following kidney transplantation that have occurred at our hospital and reviewed the published cases in China over the last 30 years.

RESULTS:

Cryptococcosis in kidney transplant recipients was mainly caused by Cryptococcus neoformans var. grubii VNI strains and occurred most frequently in patients aged 41-50 years (37.9%, 11/29). The average time to infection after kidney transplantation was 5.16 ± 3.97 years. The clinical manifestations were found to be diverse, with slight to moderate headache and fever, meningeal irritation, and high cerebrospinal fluid pressure being relatively common. Physicians should be alert to these symptoms among kidney transplant recipients.

CONCLUSIONS:

Cryptococcosis is a serious infection among kidney transplant recipients in mainland China. It has unique characteristics, such as a relatively long time to onset after kidney transplantation, and diverse clinical manifestations. Treatment with intrathecal injection of amphotericin B is considered effective for central nervous system involvement. The findings of this study also highlight the urgent need for multicenter, prospective, and multidisciplinary clinical studies and education on cryptococcosis in kidney transplant recipients in China.

• Authors: Ya-li Yang, Min Chen, Ju-lin Gu, Fan-yuan Zhu, Xiao-guang Xu, Chao Zhang, Jiang-han Chen, Wei-hua Pan, Wan-qing Liao
• Journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (Int J Infect Dis) Vol. 26 Pg. 154-61 (Sep 2014) ISSN: 1878-3511 [Electronic] Canada
• PMID: 25063020 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Topics

• Adult
• China
• Cryptococcosis (diagnosis, drug therapy, epidemiology, microbiology)
• Cryptococcus neoformans (genetics, isolation & purification)
• Female
• Hospitals, University
• Humans
• Kidney Transplantation
• Male
• Middle Aged
• Retrospective Studies
• Young Adult