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Ryosuke Osawa,
Barbara D Alexander,
Graeme N Forrest,
G Marshall Lyon, Jyoti Somani,
Ramon del Busto,
Timothy L Pruett,
Costi D Sifri,
Ajit P Limaye,
Goran B Klintmalm, [......],
Susan L Orloff,
Sally H Houston,
Dannah Wray,
Shirish Huprikar,
Leonard B Johnson,
Raymund R Razonable,
Robert A Fisher,
Marilyn M Wagener,
Shahid Husain,
Nina Singh
[show abstract]
[hide abstract]
ABSTRACT: Whether there are geographic differences in clinical presentation of cryptococcosis in solid organ transplant (SOT) recipients in the United States (US) is not known.
Patients comprised a cohort of 120 SOT recipients from US transplant centers who fulfilled the EORTC/MSG criteria for cryptococcal disease.
Central nervous system, pulmonary, and cutaneous cryptococcal disease were observed in 51% (61/120), 64% (77/120), and 15% (18/120) of the patients, respectively. Cutaneous disease was documented in 9% (3/32) of the patients from South Atlantic region, 19% (6/32) from Mid Atlantic, 26% (6/23) from Southern, 7% (2/29) from Midwestern, and in 1 of 4 patients from the Northwestern region of the US. When controlled for age, immunosuppressive regimen, type of transplant, and renal failure at baseline, patients from the Southern compared with other regions of the US were significantly more likely to have cutaneous cryptococcal disease (OR 3.8, 95% CI 1.1-14, P=0.045).
Post-transplant cryptococcosis is more likely to present with cutaneous disease in the Southern region compared with other regions in the US. This predilection for cutaneous cryptococcosis could not be explained on the basis of differences in immunosuppression or the type of transplant. Whether our findings are related to strain-related variations in characteristics of the yeast or other transplant variables remains to be determined.
Annals of transplantation: quarterly of the Polish Transplantation Society 12/2010; 15(4):77-83. · 2.02 Impact Factor
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Hsin-Yun Sun,
Barbara D Alexander,
Olivier Lortholary,
Francoise Dromer,
Graeme N Forrest,
G Marshall Lyon, Jyoti Somani,
Krishan L Gupta,
Ramon del Busto,
Timothy L Pruett, [......],
Sally H Houston,
Dannah Wray,
Shirish Huprikar,
Leonard B Johnson,
Atul Humar,
Raymund R Razonable,
Robert A Fisher,
Shahid Husain,
Marilyn M Wagener,
Nina Singh
[show abstract]
[hide abstract]
ABSTRACT: Cryptococcosis occurring ≤30 days after transplantation is an unusual event, and its characteristics are not known.
Patients included 175 solid-organ transplant (SOT) recipients with cryptococcosis in a multicenter cohort. Very early-onset and late-onset cryptococcosis were defined as disease occurring ≤30 days or >30 days after transplantation, respectively.
Very early-onset disease developed in 9 (5%) of the 175 patients at a mean of 5.7 days after transplantation. Overall, 55.6% (5 of 9) of the patients with very early-onset disease versus 25.9% (43 of 166) of the patients with late-onset disease were liver transplant recipients (P = .05). Very early cases were more likely to present with disease at unusual locations, including transplanted allograft and surgical fossa/site infections (55.6% vs 7.2%; P < .001). Two very early cases with onset on day 1 after transplantation (in a liver transplant recipient with Cryptococcus isolated from the lung and a heart transplant recipient with fungemia) likely were the result of undetected pretransplant disease. An additional 5 cases involving the allograft or surgical sites were likely the result of donor‐acquired infection.
A subset of SOT recipients with cryptococcosis present very early after transplantation with disease that appears to occur preferentially in liver transplant recipients and involves unusual sites, such as the transplanted organ or the surgical site. These patients may have unrecognized pretransplant or donor-derived cryptococcosis.
Clinical Infectious Diseases 09/2010; 51(9):1062-9. · 9.15 Impact Factor
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Hsin-Yun Sun,
Barbara D Alexander,
Olivier Lortholary,
Francoise Dromer,
Graeme N Forrest,
G Marshall Lyon, Jyoti Somani,
Krishan L Gupta,
Ramon Del Busto,
Timothy L Pruett, [......],
Sally H Houston,
Dannah Wray,
Shirish Huprikar,
Leonard B Johnson,
Atul Humar,
Raymund R Razonable,
Robert A Fisher,
Shahid Husain,
Marilyn M Wagener,
Nina Singh
[show abstract]
[hide abstract]
ABSTRACT: Clinical manifestations, treatment, and outcomes of cutaneous cryptococcosis in solid organ transplant (SOT) recipients are not fully defined. In a prospective cohort comprising 146 SOT recipients with cryptococcosis, we describe the presentation, antifungal therapy, and outcome of cutaneous cryptococcal disease. Cutaneous cryptococcosis was documented in 26/146 (17.8%) of the patients and manifested as nodular/mass (34.8%), maculopapule (30.4%), ulcer/pustule/abscess (30.4%), and cellulitis (30.4%) with 65.2% of the skin lesions occurred in the lower extremities. Localized disease developed in 30.8% (8/26), and disseminated disease in 69.2% (18/26) with involvement of the central nervous system (88.9%, 16/18), lung (33.3%, 6/18), or fungemia (55.6%, 10/18). Fluconazole (37.5%) was employed most often for localized and lipid formulations of amphotericin B (61.1%) for disseminated disease. Overall mortality at 90 days was 15.4% (4/26) with 16.7% in disseminated and 12.5% in localized disease (P = 0.78). SOT recipients who died were more likely to have renal failure (75.0% vs. 13.6%, P = 0.028), longer time to onset of disease after transplantation (87.5 vs. 22.6 months, P = 0.023), and abnormal mental status (75% vs. 13.6%, P = 0.028) than those who survived. Cutaneous cryptococcosis represents disseminated disease in most SOT recipients and preferentially involves the extremities. Outcomes with appropriate management were comparable between SOT recipients with localized and disseminated cryptococcosis.
Medical mycology: official publication of the International Society for Human and Animal Mycology 09/2010; 48(6):785-91. · 2.13 Impact Factor
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Ryosuke Osawa,
Barbara D Alexander,
Olivier Lortholary,
Françoise Dromer,
Graeme N Forrest,
G Marshall Lyon, Jyoti Somani,
Krishan L Gupta,
Ramon Del Busto,
Timothy L Pruett, [......],
Sally Houston,
Dannah Wray,
Shirish Huprikar,
Leonard B Johnson,
Atul Humar,
Raymund R Razonable,
Robert A Fisher,
Shahid Husain,
Marilyn M Wagener,
Nina Singh
[show abstract]
[hide abstract]
ABSTRACT: Cerebrospinal fluid (CSF) analysis is often deferred in patients with cryptococcal disease, particularly in the absence of neurologic manifestations. We sought to determine whether a subset of solid organ transplant (SOT) recipients with high likelihood of central nervous system (CNS) disease could be identified in whom CSF analysis must be performed.
Patients comprised a multicenter cohort of SOT recipients with cryptococcosis.
Of 129 (88%) of 146 SOT recipients with cryptococcosis who underwent CSF analysis, 80 (62%) had CNS disease. In the overall study population, abnormal mental status, time to onset of cryptococcosis more than 24 months posttransplantation (late-onset disease), serum cryptococcal antigen titer more than 1:64, and fungemia were independently associated with an increased risk of CNS disease. Of patients with abnormal mental status, 95% had CNS cryptococcosis. When only patients with normal mental status were considered, three predictors (serum antigen titer >1:64, fungemia, and late-onset disease) independently identified patients with CNS cryptococcosis; the risk of CNS disease was 14% if none, 39% if one, and 94% if two of the aforementioned predictors existed (chi for trend P<0.001).
CSF analysis should be strongly considered in SOT recipients with cryptococcosis who have late-onset disease, fungemia, or serum cryptococcal antigen titer more than 1:64 even in the presence of normal mental status.
Transplantation 01/2010; 89(1):69-74. · 4.00 Impact Factor
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Hsin-Yun Sun,
Barbara D Alexander,
Olivier Lortholary,
Francoise Dromer,
Graeme N Forrest,
G Marshall Lyon, Jyoti Somani,
Krishan L Gupta,
Ramon del Busto,
Timothy L Pruett, [......],
Susan Orloff,
Andrew A House,
Sally Houston,
Dannah Wray,
Shirish Huprikar,
Leonard B Johnson,
Atul Humar,
Raymund R Razonable,
Shahid Husain,
Nina Singh
[show abstract]
[hide abstract]
ABSTRACT: Whether outcome of central nervous system (CNS) cryptococcosis in solid organ transplant recipients treated with lipid formulations of amphotericin B is different from the outcome of the condition treated with amphotericin B deoxycholate (AmBd) is not known.
We performed a multicenter study involving a cohort comprising consecutive solid organ transplant recipients with CNS cryptococcosis.
Of 75 patients treated with polyenes as induction regimens, 55 (73.3%) received lipid formulations of amphotericin B and 20 (26.7%) received AmBd. Similar proportions of patients in both groups had renal failure at baseline (P = .94 ). Overall, mortality at 90 days was 10.9% in the group that received lipid formulations of amphotericin B and 40.0% in the group that received AmBd. In univariate analysis, nonreceipt of calcineurin inhibitors (P = .034), renal failure at baseline (P = .016), and fungemia (P = .003) were significantly associated with mortality. Compared with AmBd, lipid formulations of amphotericin B were associated with a lower mortality (P = .007). Mortality did not differ between patients receiving lipid formulations of amphotericin B with or without flucytosine (P = .349). In stepwise logistic regression analysis, renal failure at baseline (odds ratio [OR], 4.61; 95% confidence interval [CI], 1.02-20.80; P = .047) and fungemia (OR, 10.66; 95% CI, 2.08-54.55; P = .004 ) were associated with an increased mortality, whereas lipid formulations of amphotericin B were associated with a lower mortality (OR, 0.11; 95% CI, 0.02-0.57; P = .008).
Lipid formulations of amphotericin B were independently associated with better outcome and may be considered as the first-line treatment for CNS cryptococcosis in these patients.
Clinical Infectious Diseases 11/2009; 49(11):1721-8. · 9.15 Impact Factor
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Nina Singh,
Olivier Lortholary,
Françoise Dromer,
Barbara D Alexander,
Krishan L Gupta,
George T John,
Ramon del Busto,
Goran B Klintmalm, Jyoti Somani,
G Marshall Lyon, [......],
Atul Humar,
Sally Houston,
Andrew A House,
Dannah Wray,
Susan Orloff,
Lorraine A Dowdy,
Robert A Fisher,
Joseph Heitman,
Marilyn M Wagener,
Shahid Husain
[show abstract]
[hide abstract]
ABSTRACT: Prognostic implications of cryptococcal antigen and outcomes associated with central nervous system (CNS) cryptococcal lesions in solid organ transplant recipients have not been fully defined.
Patients were derived form a cohort of 122 solid organ transplant recipients with cryptococcosis in a multicenter study from 1999 to 2006.
Central nervous system cryptococcosis was documented in 61 patients. Serum or cerebral spinal fluid antigen titers did not correlate with mortality at 90 days or cerebral spinal fluid sterilization at 2 weeks. Central nervous system lesions were identified in 16 patients and included leptomeningeal lesions in eight, parenchymal lesions in six, and hydrocephalus in two. Overall, 13/16 CNS lesions were present at the time of diagnosis. One parenchymal and two hydrocephalus lesions, however, developed after diagnosis and fulfilled the criteria for immune reconstitution syndrome. Cerebral spinal fluid antigen titers were higher with meningeal versus parenchymal lesions, and hydrocephalus (P=0.015). Mortality was 50% (3/6) for patients with parenchymal, 12.5% (1/8) for those with leptomeningeal, and 0/3 for patients with hydrocephalus. Mortality was 31% (4/13) for patients with CNS lesions at baseline and 0/3 in those with new onset lesions.
Despite a higher antigen titer with meningeal lesions, outcomes tended to be worse with parenchymal compared with meningeal lesions or hydrocephalus. New onset CNS lesions may represent immune reconstitution syndrome and seemed to be associated with better outcome.
Transplantation 10/2008; 86(5):647-51. · 4.00 Impact Factor
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Dimitrios P Kontoyiannis,
Russell E Lewis,
Barbara D Alexander,
Olivier Lortholary,
Françoise Dromer,
Krishan L Gupta,
George T John,
Ramon Del Busto,
Goran B Klintmalm, Jyoti Somani, [......],
Sally Houston,
Andrew A House,
Dannah Wray,
Susan Orloff,
Lorraine A Dowdy,
Robert A Fisher,
Joseph Heitman,
Nathaniel D Albert,
Marilyn M Wagener,
Nina Singh
[show abstract]
[hide abstract]
ABSTRACT: Synergistic interactions were observed between CIs and antifungal agents against 53 (90%) of 59 Cryptococcus neoformans isolates from solid organ transplant recipients with cryptococcosis and may account for better outcomes in patients with cryptococcosis receiving these immunosuppressive agents.
Antimicrobial Agents and Chemotherapy 03/2008; 52(2):735-8. · 4.84 Impact Factor
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Nina Singh,
Barbara D Alexander,
Olivier Lortholary,
Françoise Dromer,
Krishan L Gupta,
George T John,
Ramon del Busto,
Goran B Klintmalm, Jyoti Somani,
G Marshall Lyon, [......],
Atul Humar,
Sally Houston,
Andrew A House,
Dannah Wray,
Susan Orloff,
Lorraine A Dowdy,
Robert A Fisher,
Joseph Heitman,
Marilyn M Wagener,
Shahid Husain
[show abstract]
[hide abstract]
ABSTRACT: 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.
We conducted a prospective, multicenter study of SOT recipients with pulmonary cryptococcosis during 1999-2006.
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 (P=.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).
A positive serum cryptococcal antigen test result in SOT recipients with pulmonary cryptococcosis appears to reflect extrapulmonary or more advanced radiographic disease.
Clinical Infectious Diseases 02/2008; 46(2):e12-8. · 9.15 Impact Factor
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Nina Singh,
Barbara D Alexander,
Olivier Lortholary,
Francoise Dromer,
Krishan L Gupta,
George T John,
Ramon del Busto,
Goran B Klintmalm, Jyoti Somani,
G Marshall Lyon, [......],
Atul Humar,
Sally Houston,
Andrew A House,
Dannah Wray,
Susan Orloff,
Lorraine A Dowdy,
Robert A Fisher,
Joseph Heitman,
Marilyn M Wagener,
Shahid Husain
[show abstract]
[hide abstract]
ABSTRACT: Variables influencing the risk of dissemination and outcome of Cryptococcus neoformans infection were assessed in 111 organ transplant recipients with cryptococcosis in a prospective, multicenter, international study. Sixty-one percent (68/111) of the patients had disseminated infection. The risk of disseminated cryptococcosis was significantly higher for liver transplant recipients (adjusted hazard ratio [HR], 6.65; P=.048). The overall mortality rate at 90 days was 14% (16/111). The mortality rate was higher in patients with abnormal mental status (P=.023), renal failure at baseline (P=.028), fungemia (P=.006), and disseminated infection (P=.035) and was lower in those receiving a calcineurin-inhibitor agent (P=.003). In a multivariable analysis, the receipt of a calcineurin-inhibitor agent was independently associated with a lower mortality (adjusted HR, 0.21; P=.008), and renal failure at baseline with a higher mortality rate (adjusted HR, 3.14; P=.037). Thus, outcome in transplant recipients with cryptococcosis appears to be influenced by the type of immunosuppressive agent employed. Additionally, discerning the basis for transplant type-specific differences in disease severity has implications relevant for yielding further insights into the pathogenesis of C. neoformans infection in transplant recipients.
The Journal of Infectious Diseases 04/2007; 195(5):756-64. · 6.41 Impact Factor
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Nina Singh,
Shahid Husain,
Ajit P Limaye,
Kenneth Pursell,
Goran B Klintmalm,
Timothy L Pruett, Jyoti Somani,
Valentina Stosor,
Ramon del Busto,
Marilyn M Wagener,
Chad Steele
[show abstract]
[hide abstract]
ABSTRACT: The role of Th1 and Th2 mediated cytokine responses in the pathogenesis of Cryptococcus neoformans infection in organ transplant recipients has not been defined.
We assessed cytokine levels in the sera and CSF collected prospectively at the time of diagnosis of infection in 25 transplant recipients with cryptococcosis. Serum levels were compared with those in healthy individuals and transplant recipients without cryptococcosis. IFN-gamma or IL-12 (Th1)/IL-10 (Th2) ratio < 1.0 was considered a dominant Th2 response.
Cases had lower ratios of IFN-gamma/IL-10 (p = 0.03) and IL-12/IL-10 (p = 0.03) compared to healthy individuals. Cytokine responses, however, did not differ significantly for cases vs. transplant controls. Cases with fungemia compared to those without fungemia tended to have higher serum IL-10 levels (p = 0.07) and lower IL-12/IL-10 ratios (p = 0.06). CSF ratios of IFN-gamma/IL-10 (p = 0.04) and IL-12/IL-10 (p = 0.04) were lower in cases with cryptococcal meningitis compared to those without meningitis; 80% (8/10) of the cases with cryptococcal meningitis vs. 0% (4/4) of those without meningitis had CSF IFN-gamma/IL-10 ratio of < 1.0 (p = 0.015). The levels of IL-10 (p = 0.04) and IFN-gamma (p = 0.04) in the CSF in cases with cryptococcal meningitis were significantly higher than those in their serum, respectively.
High expression of Th2 phenotype in cryptococcal meningitis and in fungemia suggests that Th dysregulation may contribute to the pathogenesis of cryptococcosis in organ transplant recipients.
Transplant Immunology 08/2006; 16(2):69-72. · 1.46 Impact Factor
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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, [......],
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
[show abstract]
[hide abstract]
ABSTRACT: Therapeutic practices for Cryptococcus neoformans infection in transplant recipients vary, particularly with regards to antifungal agent employed, and duration of therapy. The risk of relapse and time to recurrence is not known. We assessed antifungal treatment practices for cryptococcosis in a cohort of prospectively followed organ transplant recipients.
The patients comprised 83 transplant recipients with cryptococcosis followed for a median of 2.1 and up to 5.2 years.
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.
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.
Transplantation 11/2005; 80(8):1033-9. · 4.00 Impact Factor
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Nina Singh,
Olivier Lortholary,
Barbara D Alexander,
Krishan L Gupta,
George T John,
Kenneth Pursell,
Patricia Munoz,
Goran B Klintmalm,
Valentina Stosor,
Ramon delBusto, [......],
Marshall Lyon,
Sally Houston,
Andrew A House,
Timothy L Pruett,
Susan Orloff,
Atul Humar,
Lorraine Dowdy,
Julia Garcia-Diaz,
Robert A Fisher,
Shahid Husain
[show abstract]
[hide abstract]
ABSTRACT: This study describes the association of allograft loss and immune reconstitution syndrome (IRS) in the course of Cryptococcosis neoformans infection in renal transplant recipients. Patients comprised 54 renal allograft recipients with cryptococcosis in a prospective, multicenter study. IRS developed in 5.5% (3/54) of the renal transplant recipient with C. neoformans infection. The renal allograft was lost to chronic rejection in 66% (2/3) of the patients with cryptococcosis who developed IRS compared to 5.9% (3/51) of those who did not (P=0.012). Kaplan-Meier survival analysis showed that subsequent to cryptococcal infection the probability of allograft survival was significantly lower in patients who developed IRS compared to those who did not develop IRS (P=0.0004). Temporal association of graft loss with IRS suggests a common pathophysiologic basis for these entities with implications relevant for the optimal management of renal transplant recipients with cryptococcosis.
Transplantation 11/2005; 80(8):1131-3. · 4.00 Impact Factor
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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, [......],
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
[show abstract]
[hide abstract]
ABSTRACT: We describe an immune reconstitution syndrome (IRS)-like entity in the course of evolution of Cryptococcus neoformans infection in organ transplant recipients.
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.
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.
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.
Clinical Infectious Diseases 07/2005; 40(12):1756-61. · 9.15 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Unique characteristics, impact of therapy with antifungal agents, and outcome of infections with Scedosporium species were assessed in transplant recipients.
The patients comprised a total of 80 transplant recipients with Scedosporium infections, including 13 patients from our institutions (University of Pittsburgh Medical Center [Pittsburgh, PA], University of Maryland [Baltimore], Duke University Medical Center [Durham, NC], Emory University [Atlanta, GA], and Hospital Gregorio Maranon [Madrid, Spain]) and 67 reported in the literature. The transplant recipients were compared with 190 non-transplant recipients with scedosporiosis who were described in the literature.
Overall, 69% of the infections in hematopoietic stem cell transplant (HSCT) recipients and 53% of the infections in organ transplant recipients were disseminated. HSCT recipients, compared with organ transplant recipients, were more likely to have infections caused by Scedosporium prolificans (P=.045), to have an earlier onset of infection (P=.007), to be neutropenic (P<.0001), and to have fungemia (P=.04). Time elapsed from transplantation to Scedosporium infection in transplant recipients has increased in recent years (P=.002). The mortality rate among transplant recipients with scedosporiosis was 58%. In a logistic regression model using amphotericin B as comparison treatment, voriconazole was associated with a trend towards better survival (odds ratio [OR], 10.40; P=.08). Presence of disseminated infection (OR, 0.20; P=.03) predicted lower survival, and receipt of adjunctive surgery as treatment (OR, 5.52; P=.02) independently predicted a better survival in this model.
Scedosporium infections in transplant recipients were associated with a high rate of dissemination and a poor outcome overall. The use of newer triazole agents warrants consideration as a therapeutic modality for these infections.
Clinical Infectious Diseases 02/2005; 40(1):89-99. · 9.15 Impact Factor
