Cryptococcosis in Renal Transplant Recipients: A Single-Center Experience

Marques, Sofia; Carmo, Rute; Ferreira, Inês; Bustorff, Manuela; Sampaio, Susana; Pestana, Manuel

doi:10.1016/j.transproceed.2016.06.006

Cited by 15 publications

(9 citation statements)

References 16 publications

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“…In the current literature there are numerous reports of viral, parasitic, fungal and bacterial transmission (including Polyomavirus, Cytomegalovirus, Cryptococcosis, Mucormycosis, Acinetobacters, and non-tuberculous Mycobacteriums) through transplants. [1,[6][7][8][9] Among these Cytomegalovirus is the most common viral infection after renal Tx and is associated with significant morbidity including acute rejection and mortality. It is closely related to effective immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of early and late-term infections after renal transplantation: Clinical experiences of Sanko University Medical Faculty Transplantation Center

Kazımoğlu

Harman

Mercimek

et al. 2019

Turkish Journal of Urology

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The most common complication after renal transplantation are infections. The majority of the infections are seen within the first year especially between 1-6 months. Post-transplant infections are often related to urinary system. E.coli is the most frequently isolated agent and it may be responsible for urosepsis in renal transplant patients. Infection more often seen in renal transplantations from cadavers.

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Section: Discussionmentioning

confidence: 99%

Evaluation of early and late-term infections after renal transplantation: Clinical experiences of Sanko University Medical Faculty Transplantation Center

Kazımoğlu

Harman

Mercimek

et al. 2019

Turkish Journal of Urology

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“…This case represents a rare presentation of two serious infectionsin non-AIDS hemodialysis patient post-rejected renal transplantation within 4 weeks of discontinuation of immunosuppressant therapy. Isolated disseminated cryptococcosishas been sporadically described in patients with renal failure, nephrotic syndrome and in renal allograft recipients [7][8][9]. Concomitant infections, however, have been described as care reports in fewAIDS patients and on rare occasions in apparently immunocompetent adults [10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Concurrent Disseminated Cryptococcus neoformans and Abdominal Tuberculosis in a Renal Transplant Recipient – Paradoxical Reaction or IRIS?

2017

AIDT

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A 36 year old-man diagnosed with ESRD on hemodialysis, presented with fever, moderate abdominal pain with frequent non-bloody loose stools, headache, blurring of vision and molloscum-contagiousum like skin lesions. HIV test was negative and CT brain was normal. Blood culture grew Cryptococcus neoformans with high titer antigenemia. Amphotericin B and fluconazole were started and the patient was discharged on oral fluconazole therapy. Four weeks later, he was readmitted with persistent high spikes of temperature, profuse sweating and severe frontal headache. CT brain revealed a faint hypodense lesion at right frontal lobe with ill-defined margin and lumbar puncture was deferred. Pan-sensitive mycobacterium tuberculosis was grown from stool sample. Blood cryptococcalantigenemia was reported again and he was started on a new IV amphotericin intensive cycle and high dose fluconazole. Quadruple anti-tuberculosis treatment was initiated. The patient made a full clinical recovery including total resolution of skin lesions; laboratory and radiological recovery.

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“…Transplant recipients frequently develop central nervous system complications (50-75%) [ 9 ], being cryptococcal meningoencephalitis (CM) the most common problem. Although the incidence of CM among kidney transplant recipients is 0.2-5%, mortality rates are high (20-49%) [ 4 , 7 , 10 , 11 ]. In the two cases reported in this paper, infection was associated with neurologic symptoms suggestive of CM, and despite antifungal therapy, evolution was torpid.…”

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confidence: 99%

“…Additionally, the two patients exhibited an increase in CMV viral load parallel to CM presentation. In a case review, Marques et al [ 11 ] suggested a possible association between CMV infection and cryptococcosis.…”

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confidence: 99%

“…For the management of disseminated cryptococcosis, current guidelines recommend induction therapy with liposomal amphotericin plus flucytosine (can be replaced with fluconazole) followed by fluconazole in the consolidation and maintenance phase [ 11 , 21 ]. However, itraconazole, voriconazole and isavuconazole have been successfully used in the induction phase [ 9 ].…”

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confidence: 99%

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Cryptococcal infection in renal transplant: two case reports and a literature review

Rojo-Martín

Peinado²,

Mesa³

et al. 2021

Rev Esp Quimioter

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The first case was a 64-year-old woman with chronic kidney failure secondary to nephroangiosclerosis and nonsteroidal anti-inflammatory drug use, who received a kidney transplant in July 2017. Immunosuppressive therapy included prednisone, tacrolimus, and mycophenolate. In October 2018, the patient was admitted for a two-week history of progressive cephalea, diplopia and occasional speech problems, although the patient remained afebrile. Routine serum chemistry was normal, except for creatinine 2.75 mg/dL and a glomerular filtration (GF) of 18 mL/min. Brain CT scan was normal. Findings in cerebrospinal fluid (CSF) were consistent with lymphocytic meningoencephalitis (Table 1). Bacterial and fungal culture was negative, as were nucleic-acid amplification tests (NAATs) for bacteria, mycobacteria, virus, and fungi. Empirical treatment with acyclovir (350 mg/24 h, IV), ceftriaxone (2 g/12 h IV), and antituberculous drugs was started. Mycophenolate was suspended, whereas tacrolimus and prednisone were maintained at previous doses. After a week, the patient developed neurological deterioration. A new lumbar puncture was performed and NAAT was positive for Cryptococcus neoformans/gatti. A yeast was isolated from culture and identified as C. neoformans by mass spectrometry (MALDI-TOF). Antifungal therapy with liposomal amphotericin B (250 mg/24h IV) and fluconazole (200 mg/12 h IV) was initiated and neurologic function of the patient improved significantly. Simultaneously, tacrolimus was suspended. After 10 days of antifungal treatment, the viral load of CMV progressively increased, and ganciclovir (115 mg/24 h) was added. Tacrolimus at low doses (1mg/day) was restarted at 14 days. India-ink staining of CSF obtained by control lumbar punctures performed weekly was persistently positive and C. neoformans was isolated again from culture. Four weeks after diagnosis, the patient developed pancytopenia, which was probably linked to drug toxicity and ganciclovir was withdrawn. After this finding, the patient had fever, dyspnea, and rapid progressive general deterioration resulting in death 34 days after admission. Streptococcus pneumoniae was isolated in blood culture.

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Cryptococcosis in Renal Transplant Recipients: A Single-Center Experience

Cited by 15 publications

References 16 publications

Evaluation of early and late-term infections after renal transplantation: Clinical experiences of Sanko University Medical Faculty Transplantation Center

Evaluation of early and late-term infections after renal transplantation: Clinical experiences of Sanko University Medical Faculty Transplantation Center

Concurrent Disseminated Cryptococcus neoformans and Abdominal Tuberculosis in a Renal Transplant Recipient – Paradoxical Reaction or IRIS?

Cryptococcal infection in renal transplant: two case reports and a literature review

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