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Cryptococcal Meningitis in Kidney Transplant Recipients: A Two-Decade Cohort Study in France

Authors :
Laurène Tardieu
Gillian Divard
Olivier Lortholary
Anne Scemla
Éric Rondeau
Isabelle Accoceberry
Rémi Agbonon
Alexandre Alanio
Adela Angoulvant
Laetitia Albano
Philippe Attias
Anne Pauline Bellanger
Dominique Bertrand
Julie Bonhomme
Françoise Botterel
Nicolas Bouvier
Matthias Buchler
Taieb Chouaki
Thomas Crépin
Marie-Fleur Durieux
Guillaume Desoubeaux
Gary Doppelt
Loïc Favennec
Arnaud Fekkar
Ophélie Fourdinier
Marie Frimat
Jean-Pierre Gangneux
Claire Garandeau
Lilia Hasseine
Christophe Hennequin
Xavier Iriart
Nassim Kamar
Hannah Kaminski
Raphael Kormann
Laurence Lachaud
Christophe Legendre
Moglie Le Quintrec Donnette
Jordan Leroy
Charlène Levi
Marie Machouart
David Marx
Jean Menotti
Valérie Moal
Florent Morio
Natacha Mrozek
Muriel Nicolas
Philippe Poirier
Marie-Noelle Peraldi
Benjamin Poussot
Stéphane Ranque
Jean-Philippe Rerolle
Boualem Sendid
Renaud Snanoudj
Jérôme Tourret
Marc Vasse
Cécile Vigneau
Odile Villard
Laurent Mesnard
Fanny Lanternier
Cédric Rafat
Source :
Pathogens, Vol 11, Iss 6, p 699 (2022)
Publication Year :
2022
Publisher :
MDPI AG, 2022.

Abstract

Cryptococcosis is the third most common cause of invasive fungal infection in solid organ transplant recipients and cryptococcal meningitis (CM) its main clinical presentation. CM outcomes, as well as its clinical features and radiological characteristics, have not yet been considered on a large scale in the context of kidney transplantation (KT). We performed a nationwide retrospective study of adult patients diagnosed with cryptococcosis after KT between 2002 and 2020 across 30 clinical centers in France. We sought to describe overall and graft survival based on whether KT patients with cryptococcosis developed CM or not. Clinical indicators of CNS involvement and brain radiological characteristics were assessed. Eighty-eight cases of cryptococcosis were diagnosed during the study period, with 61 (69.3%) cases of CM. Mortality was high (32.8%) at 12 months (M12) but not significantly different whether or not patients presented with CM. Baseline hyponatremia and at least one neurological symptom were independently associated with CM (p < 0.001). Positive serum cryptococcal antigen at diagnosis was also significantly associated with CM (p < 0.001). On magnetic resonance imaging (MRI), three patterns of brain injury were identified: parenchymal, meningeal, and vascular lesions. Although CM does not affect graft function directly, it entails a grim prognosis.

Details

Language :
English
ISSN :
20760817
Volume :
11
Issue :
6
Database :
Directory of Open Access Journals
Journal :
Pathogens
Publication Type :
Academic Journal
Accession number :
edsdoj.4894d8c53d4107bece9ebf343efbfa
Document Type :
article
Full Text :
https://doi.org/10.3390/pathogens11060699