Geographic differences in disease expression of cryptococcosis in solid organ transplant recipients in the United States

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, Kenneth Pursell, Valentina Stosor, Michele I Morris, Lorraine A. Dowdy, Andre C. Kalil, Julia Garcia-Diaz, Susan L. Orloff, Sally H. Houston, Dannah Wray, Shirish Huprikar & 6 others Leonard B. Johnson, Raymund R. Razonable, Robert A. Fisher, Marilyn M. Wagener, Shahid Husain, Nina Singh

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Whether there are geographic differences in clinical presentation of cryptococcosis in solid organ transplant (SOT) recipients in the United States (US) is not known. Material/Methods: Patients comprised a cohort of 120 SOT recipients from US transplant centers who fulfilled the EORTC/MSG criteria for cryptococcal disease. Results: 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). Conclusions: 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.

Original languageEnglish
Pages (from-to)77-83
Number of pages7
JournalAnnals of Transplantation
Volume15
Issue number4
StatePublished - Dec 1 2010

Fingerprint

Cryptococcosis
Transplants
Skin Diseases
Northwestern United States
Sodium Glutamate
Immunosuppressive Agents
Transplant Recipients
Immunosuppression
Renal Insufficiency
Central Nervous System
Yeasts
Lung
Skin

Keywords

  • Cryptococcosis
  • Epidemiology
  • Geography
  • Skin diseases
  • Solid organ transplant

ASJC Scopus subject areas

  • Transplantation

Cite this

Osawa, R., Alexander, B. D., Forrest, G. N., Lyon, G. M., Somani, J., del Busto, R., ... Singh, N. (2010). Geographic differences in disease expression of cryptococcosis in solid organ transplant recipients in the United States. Annals of Transplantation, 15(4), 77-83.

Geographic differences in disease expression of cryptococcosis in solid organ transplant recipients in the United States. / Osawa, Ryosuke; Alexander, Barbara D.; Forrest, Graeme N.; Lyon, G. Marshall; Somani, Jyoti; del Busto, Ramon; Pruett, Timothy L.; Sifri, Costi D.; Limaye, Ajit P.; Klintmalm, Goran B.; Pursell, Kenneth; Stosor, Valentina; Morris, Michele I; Dowdy, Lorraine A.; Kalil, Andre C.; Garcia-Diaz, Julia; Orloff, Susan L.; Houston, Sally H.; Wray, Dannah; Huprikar, Shirish; Johnson, Leonard B.; Razonable, Raymund R.; Fisher, Robert A.; Wagener, Marilyn M.; Husain, Shahid; Singh, Nina.

In: Annals of Transplantation, Vol. 15, No. 4, 01.12.2010, p. 77-83.

Research output: Contribution to journalArticle

Osawa, R, Alexander, BD, Forrest, GN, Lyon, GM, Somani, J, del Busto, R, Pruett, TL, Sifri, CD, Limaye, AP, Klintmalm, GB, Pursell, K, Stosor, V, Morris, MI, Dowdy, LA, Kalil, AC, Garcia-Diaz, J, Orloff, SL, Houston, SH, Wray, D, Huprikar, S, Johnson, LB, Razonable, RR, Fisher, RA, Wagener, MM, Husain, S & Singh, N 2010, 'Geographic differences in disease expression of cryptococcosis in solid organ transplant recipients in the United States', Annals of Transplantation, vol. 15, no. 4, pp. 77-83.
Osawa R, Alexander BD, Forrest GN, Lyon GM, Somani J, del Busto R et al. Geographic differences in disease expression of cryptococcosis in solid organ transplant recipients in the United States. Annals of Transplantation. 2010 Dec 1;15(4):77-83.
Osawa, Ryosuke ; Alexander, Barbara D. ; Forrest, Graeme N. ; Lyon, G. Marshall ; Somani, Jyoti ; del Busto, Ramon ; Pruett, Timothy L. ; Sifri, Costi D. ; Limaye, Ajit P. ; Klintmalm, Goran B. ; Pursell, Kenneth ; Stosor, Valentina ; Morris, Michele I ; Dowdy, Lorraine A. ; Kalil, Andre C. ; Garcia-Diaz, Julia ; Orloff, Susan L. ; Houston, Sally H. ; Wray, Dannah ; Huprikar, Shirish ; Johnson, Leonard B. ; Razonable, Raymund R. ; Fisher, Robert A. ; Wagener, Marilyn M. ; Husain, Shahid ; Singh, Nina. / Geographic differences in disease expression of cryptococcosis in solid organ transplant recipients in the United States. In: Annals of Transplantation. 2010 ; Vol. 15, No. 4. pp. 77-83.
@article{702fbc3a940f4b6898abe890804685fc,
title = "Geographic differences in disease expression of cryptococcosis in solid organ transplant recipients in the United States",
abstract = "Background: Whether there are geographic differences in clinical presentation of cryptococcosis in solid organ transplant (SOT) recipients in the United States (US) is not known. Material/Methods: Patients comprised a cohort of 120 SOT recipients from US transplant centers who fulfilled the EORTC/MSG criteria for cryptococcal disease. Results: 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). Conclusions: 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.",
keywords = "Cryptococcosis, Epidemiology, Geography, Skin diseases, Solid organ transplant",
author = "Ryosuke Osawa and Alexander, {Barbara D.} and Forrest, {Graeme N.} and Lyon, {G. Marshall} and Jyoti Somani and {del Busto}, Ramon and Pruett, {Timothy L.} and Sifri, {Costi D.} and Limaye, {Ajit P.} and Klintmalm, {Goran B.} and Kenneth Pursell and Valentina Stosor and Morris, {Michele I} and Dowdy, {Lorraine A.} and Kalil, {Andre C.} and Julia Garcia-Diaz and Orloff, {Susan L.} and Houston, {Sally H.} and Dannah Wray and Shirish Huprikar and Johnson, {Leonard B.} and Razonable, {Raymund R.} and Fisher, {Robert A.} and Wagener, {Marilyn M.} and Shahid Husain and Nina Singh",
year = "2010",
month = "12",
day = "1",
language = "English",
volume = "15",
pages = "77--83",
journal = "Annals of Transplantation",
issn = "1425-9524",
publisher = "International Scientific Information, Inc.",
number = "4",

}

TY - JOUR

T1 - Geographic differences in disease expression of cryptococcosis in solid organ transplant recipients in the United States

AU - Osawa, Ryosuke

AU - Alexander, Barbara D.

AU - Forrest, Graeme N.

AU - Lyon, G. Marshall

AU - Somani, Jyoti

AU - del Busto, Ramon

AU - Pruett, Timothy L.

AU - Sifri, Costi D.

AU - Limaye, Ajit P.

AU - Klintmalm, Goran B.

AU - Pursell, Kenneth

AU - Stosor, Valentina

AU - Morris, Michele I

AU - Dowdy, Lorraine A.

AU - Kalil, Andre C.

AU - Garcia-Diaz, Julia

AU - Orloff, Susan L.

AU - Houston, Sally H.

AU - Wray, Dannah

AU - Huprikar, Shirish

AU - Johnson, Leonard B.

AU - Razonable, Raymund R.

AU - Fisher, Robert A.

AU - Wagener, Marilyn M.

AU - Husain, Shahid

AU - Singh, Nina

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Background: Whether there are geographic differences in clinical presentation of cryptococcosis in solid organ transplant (SOT) recipients in the United States (US) is not known. Material/Methods: Patients comprised a cohort of 120 SOT recipients from US transplant centers who fulfilled the EORTC/MSG criteria for cryptococcal disease. Results: 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). Conclusions: 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.

AB - Background: Whether there are geographic differences in clinical presentation of cryptococcosis in solid organ transplant (SOT) recipients in the United States (US) is not known. Material/Methods: Patients comprised a cohort of 120 SOT recipients from US transplant centers who fulfilled the EORTC/MSG criteria for cryptococcal disease. Results: 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). Conclusions: 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.

KW - Cryptococcosis

KW - Epidemiology

KW - Geography

KW - Skin diseases

KW - Solid organ transplant

UR - http://www.scopus.com/inward/record.url?scp=78651232504&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78651232504&partnerID=8YFLogxK

M3 - Article

VL - 15

SP - 77

EP - 83

JO - Annals of Transplantation

JF - Annals of Transplantation

SN - 1425-9524

IS - 4

ER -