Overview

Cryptococcosis is the third most commonly occurring invasive fungal infection in solid organ transplant (SOT) recipients. The overall incidence of cryptococcosis in SOT recipients ranges from 0.2-5%.  Cryptococcosis is typically a late-occurring infection; the median time to onset usually ranges from 16 - 21 months post-transplantation. Cryptococcal disease in SOT recipients is considered to represent reactivation of quiescent infection.  Although rare, cases of transmission from donor organ and tissue grafts are being recognized, and should be considered when diagnosis occurs in the recipient within 30-days of transplant.  Infection usually manifests as CNS disease (meningitis) or pneumonia. The recommended treatment for cryptococcal meningitis is an ampothericin B preparation plus flucytosine; complete or partial responses are seen in most (>85%) patients. Overall mortality in SOT recipients with cryptococcosis in the current era is 14%. Relapse of cryptococcosis is rare among transplant recipients who have received recommended therapy.  Recent topics of interest among transplant recipients include the emergence of Cryptococcus gattii infections, immune reconstitution inflammatory syndrome, and impact of diagnosis of pre-transplant cryptococcosis on transplantation. This talk will discuss current strategies on management of cryptococcosis pre and post-transplant.  

Objectives

1- Identify risk factors for cryptococcosis in transplant patients (pre- and post-transplant).

2- Outline the principles of management of cryptococcal meningitis pre- and post-transplant, including immune reconstitution inflammatory syndrome

3- Emphasize Cryptococcus gattii as an emerging pathogen causing meningoencephalitis in transplant patients