Cryptococcosis in solid organ transplant recipients

Abstract

Purpose of review: Cryptococcosis among solid organ transplant (SOT) recipients is a source of significant morbidity. Its pathogenesis, the etiology of immune reconstitution syndrome, and the optimal therapy in this setting are still not well defined. Herein, we review the epidemiology, the latest findings on pathogenesis, unique clinical manifestations, and the treatment of Cryptococcosis in this specific vulnerable population.

Recent findings: Cryptococcosis is a common fungal complication among SOT recipients. It follows in frequency only to aspergillosis and candidiasis. Cryptococcal infection carries a high mortality, up to 27% during the first year posttransplantation. Host factors, environmental factors, medications, and the type of transplant all play a role in the clinical presentation and severity of infection. Clinical manifestations can be atypical among SOT recipients, and therefore, clinical suspicion and diagnostic evaluation must consider cryptococcal central nervous system disease. During meningitis treatment, measurement of Flucytosine levels is recommended to increase safety and optimize the therapeutic effect.

Summary: Cryptococcosis among SOT recipients is an evolving field. Increased recognition and understanding of the disease pathogenesis, its uncommon clinical manifestations, complications and particular therapeutic strategies are the cornerstone for the optimal outcome of this often fatal condition.