A Comparison of Cryptococcal Meningitis in Solid Organ Transplant Recipients Versus Human Immunodeficiency Virus-Infected Individuals

Ref ID: 19268

Author:

T. Sparkes, C. Brickman, E. A. Blumberg, M. B. Wilck

Author address:

Perelman Sch. of Med. of the Univ. of Pennsylvania, Philadelphia, PA.

Full conference title:

53rd Interscience Conference on Antimicrobial Agents and Chemotherapy

Date: 10 September 2014

Abstract:

Background: The management of cryptococcal meningitis in solid organ transplant (SOT) recipients has been largely extrapolated from the treatment of cryptococcal infection in Human immunodeficiency virus (HIV)-infected individuals. At our institution, it has been observed that many SOT patients (pts) with cryptococcal infection have been unable to complete the recommended treatment as outlined by the Infectious Diseases Society of America (IDSA) cryptococcal guidelines, largely due to medication-related adverse effects. Consequently, it remains unclear whether this strategy should continue to be first line treatment strategy for these pts. The purpose of this study was to compare the management of cryptococcal infections in SOT recipients versus HIV-infected pts. Methods: This retrospective, single-center study included all adult pts who received a SOT or were infected with HIV who were treated for cryptococcal meningitis infection between January 1, 2006 and December 31, 2012. The minimum follow-up period after infection was 2 weeks. Results: 13 SOT recipients and 12 HIV-infected individuals developed cryptococcal meningitis. Fewer SOT pts were able to complete the recommended course of combination amphotericin and flucytosine (31% vs. 50%, p=0.428), in part due to the difference in the duration of amphotericin
administration (p = 0.0462). The main reason that SOT pts
did not receive 2 weeks of either amphotericin and/or
flucytosine was due to drug-related adverse effects
including acute kidney injury (46%) and cytopenias (15%).
Deaths related to cryptococcal infection were higher in the
SOT group (38% vs. 8%, p=0.322).

Conclusions: SOT recipients with cryptococcal meningitis were less able to tolerate guideline-driven therapy when compared to their HIV-infected counterparts. The mortality rate was not significantly different between groups. These results suggest a possible need for unique treatment guidelines for SOT recipients developing cryptococcal infection.

Abstract Number: NULL

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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