Cutaneous cryptococcosis in solid organ transplant recipients

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; Costi D. Sifri; Ajit P. Limaye; George T. John; Goran B. Klintmalm; Kenneth Pursell; Valentina Stosor; Michele I. Morris; Lorraine A. Dowdy; Patricia Muoz; Andre C. Kalil; Julia Garcia-Diaz; Susan L. Orloff; Andrew A. House; 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

doi:10.3109/13693780903496617

Cutaneous cryptococcosis in solid organ transplant recipients

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, Costi D. Sifri, Ajit P. Limaye, George T. John, Goran B. Klintmalm, Kenneth Pursell, Valentina Stosor, Michele I. Morris, Lorraine A. Dowdy, Patricia Muoz, Andre C. KalilJulia Garcia-Diaz, Susan L. Orloff, Andrew A. House, 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

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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.

Original language	English (US)
Pages (from-to)	785-791
Number of pages	7
Journal	Medical mycology
Volume	48
Issue number	6
DOIs	https://doi.org/10.3109/13693780903496617
State	Published - Sep 2010

Bibliographical note

Funding Information:
Declarations of interest: Barbara D. Alexander has served on advisory boards for Enzon, Basilea, Abbott, and Schering-Plough, served on speaker’s bureaus of Astellas and Pfizer, and received grants from Astellas, Enzon, and Pfizer; Graeme Forrest has received a grant from Astellas. G. Marshall Lyon has served on advisory boards for and received grants from Merck and Astellas, and on speaker’s bureaus of Astellas, Schering-Plough, and Wyeth; Kenneth Pursell has served on a speaker’s bureau of Merck; Michele I. Morris has served on advisory boards for Astellas, Pfizer, and Merck, has received grants from Astellas, Basilea, and Pfizer, and has served on speaker’s bureaus of Astellas and Pfizer; Patricia Munoz has served on speaker’s bureaus of Merck and Novartis and on an advisory board for Pfizer; Sally H. Houston has served on speaker’s bureaus of Astellas and Pfizer; Leonard B. Johnson has served on a speaker’s bureau of Pfizer; Shahid Husain has served on consultant boards for and received grants from Pfizer, Astellas, and Schering-Plough; Nina Singh has received a grant from Pfizer; other authors have no conflicts.

Keywords

Cryptococcus
Fungal infections
Transplants

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10.3109/13693780903496617

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Sun, H. Y., Alexander, B. D., Lortholary, O., Dromer, F., Forrest, G. N., Lyon, G. M., Somani, J., Gupta, K. L., Busto, R. D., Pruett, T. L., Sifri, C. D., Limaye, A. P., John, G. T., Klintmalm, G. B., Pursell, K., Stosor, V., Morris, M. I., Dowdy, L. A., Muoz, P., ... Singh, N. (2010). Cutaneous cryptococcosis in solid organ transplant recipients. Medical mycology, 48(6), 785-791. https://doi.org/10.3109/13693780903496617

Sun, HY, Alexander, BD, Lortholary, O, Dromer, F, Forrest, GN, Lyon, GM, Somani, J, Gupta, KL, Busto, RD, Pruett, TL, Sifri, CD, Limaye, AP, John, GT, Klintmalm, GB, Pursell, K, Stosor, V, Morris, MI, Dowdy, LA, Muoz, P, Kalil, AC, Garcia-Diaz, J, Orloff, SL, House, AA, Houston, SH, Wray, D, Huprikar, S, Johnson, LB, Humar, A, Razonable, RR, Fisher, RA, Husain, S, Wagener, MM & Singh, N 2010, 'Cutaneous cryptococcosis in solid organ transplant recipients', Medical mycology, vol. 48, no. 6, pp. 785-791. https://doi.org/10.3109/13693780903496617

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title = "Cutaneous cryptococcosis in solid organ transplant recipients",

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.",

keywords = "Cryptococcus, Fungal infections, Transplants",

author = "Sun, {Hsin Yun} and Alexander, {Barbara D.} and Olivier Lortholary and Francoise Dromer and Forrest, {Graeme N.} and Lyon, {G. Marshall} and Jyoti Somani and Gupta, {Krishan L.} and Busto, {Ramon Del} and Pruett, {Timothy L.} and Sifri, {Costi D.} and Limaye, {Ajit P.} and John, {George T.} and Klintmalm, {Goran B.} and Kenneth Pursell and Valentina Stosor and Morris, {Michele I.} and Dowdy, {Lorraine A.} and Patricia Muoz and Kalil, {Andre C.} and Julia Garcia-Diaz and Orloff, {Susan L.} and House, {Andrew A.} and Houston, {Sally H.} and Dannah Wray and Shirish Huprikar and Johnson, {Leonard B.} and Atul Humar and Razonable, {Raymund R.} and Fisher, {Robert A.} and Shahid Husain and Wagener, {Marilyn M.} and Nina Singh",

note = "Funding Information: Declarations of interest: Barbara D. Alexander has served on advisory boards for Enzon, Basilea, Abbott, and Schering-Plough, served on speaker{\textquoteright}s bureaus of Astellas and Pfizer, and received grants from Astellas, Enzon, and Pfizer; Graeme Forrest has received a grant from Astellas. G. Marshall Lyon has served on advisory boards for and received grants from Merck and Astellas, and on speaker{\textquoteright}s bureaus of Astellas, Schering-Plough, and Wyeth; Kenneth Pursell has served on a speaker{\textquoteright}s bureau of Merck; Michele I. Morris has served on advisory boards for Astellas, Pfizer, and Merck, has received grants from Astellas, Basilea, and Pfizer, and has served on speaker{\textquoteright}s bureaus of Astellas and Pfizer; Patricia Munoz has served on speaker{\textquoteright}s bureaus of Merck and Novartis and on an advisory board for Pfizer; Sally H. Houston has served on speaker{\textquoteright}s bureaus of Astellas and Pfizer; Leonard B. Johnson has served on a speaker{\textquoteright}s bureau of Pfizer; Shahid Husain has served on consultant boards for and received grants from Pfizer, Astellas, and Schering-Plough; Nina Singh has received a grant from Pfizer; other authors have no conflicts.",

year = "2010",

month = sep,

doi = "10.3109/13693780903496617",

language = "English (US)",

volume = "48",

pages = "785--791",

journal = "Medical mycology",

issn = "1369-3786",

publisher = "Informa Healthcare",

number = "6",

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TY - JOUR

T1 - Cutaneous cryptococcosis in solid organ transplant recipients

AU - Sun, Hsin Yun

AU - Alexander, Barbara D.

AU - Lortholary, Olivier

AU - Dromer, Francoise

AU - Forrest, Graeme N.

AU - Lyon, G. Marshall

AU - Somani, Jyoti

AU - Gupta, Krishan L.

AU - Busto, Ramon Del

AU - Pruett, Timothy L.

AU - Sifri, Costi D.

AU - Limaye, Ajit P.

AU - John, George T.

AU - Klintmalm, Goran B.

AU - Pursell, Kenneth

AU - Stosor, Valentina

AU - Morris, Michele I.

AU - Dowdy, Lorraine A.

AU - Muoz, Patricia

AU - Kalil, Andre C.

AU - Garcia-Diaz, Julia

AU - Orloff, Susan L.

AU - House, Andrew A.

AU - Houston, Sally H.

AU - Wray, Dannah

AU - Huprikar, Shirish

AU - Johnson, Leonard B.

AU - Humar, Atul

AU - Razonable, Raymund R.

AU - Fisher, Robert A.

AU - Husain, Shahid

AU - Wagener, Marilyn M.

AU - Singh, Nina

N1 - Funding Information: Declarations of interest: Barbara D. Alexander has served on advisory boards for Enzon, Basilea, Abbott, and Schering-Plough, served on speaker’s bureaus of Astellas and Pfizer, and received grants from Astellas, Enzon, and Pfizer; Graeme Forrest has received a grant from Astellas. G. Marshall Lyon has served on advisory boards for and received grants from Merck and Astellas, and on speaker’s bureaus of Astellas, Schering-Plough, and Wyeth; Kenneth Pursell has served on a speaker’s bureau of Merck; Michele I. Morris has served on advisory boards for Astellas, Pfizer, and Merck, has received grants from Astellas, Basilea, and Pfizer, and has served on speaker’s bureaus of Astellas and Pfizer; Patricia Munoz has served on speaker’s bureaus of Merck and Novartis and on an advisory board for Pfizer; Sally H. Houston has served on speaker’s bureaus of Astellas and Pfizer; Leonard B. Johnson has served on a speaker’s bureau of Pfizer; Shahid Husain has served on consultant boards for and received grants from Pfizer, Astellas, and Schering-Plough; Nina Singh has received a grant from Pfizer; other authors have no conflicts.

PY - 2010/9

Y1 - 2010/9

N2 - 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.

AB - 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.

KW - Cryptococcus

KW - Fungal infections

KW - Transplants

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ER -

Cutaneous cryptococcosis in solid organ transplant recipients

Abstract

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