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Nina Singh - One of the best experts on this subject based on the ideXlab platform.
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How I treat cryptococcosis in Organ Transplant recipients.
Transplantation, 2012Co-Authors: Nina SinghAbstract:Cryptococcosis is a significant opportunistic mycoses in Organ Transplant recipients. Topical developments in the field in the past few years have highlighted important issues and at the same time raised new questions regarding the management of this yeast. These include, for example, management of preTransplant cryptococcosis during Transplant candidacy and timing of Transplant in these instances; potential for donor transmission of cryptococcosis in light of recent fatal transmissions; and prevention and treatment of Cryptococcus-associated immune reconstitution syndrome. Discussed herein are challenges posed by these issues and evidence-based data to optimize the management of postTransplant cryptococcosis.
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cryptococcosis in solid Organ Transplant recipients current state of the science
Clinical Infectious Diseases, 2008Co-Authors: Nina Singh, Francoise Dromer, Olivier Lortholary, John R. PerfectAbstract:Cryptococcosis remains a significant opportunistic infection in solid Organ Transplant recipients. Disease presentation and outcomes may be affected by, among other factors, the use of calcineurin inhibitor immunosuppressive agents. It is being increasingly recognized that rapid reversal of immunosuppression in Transplant recipients treated for cryptococcosis incurs the risk of immune reconstitution inflammatory syndrome, which resembles worsening disease or relapse. This review summarizes the current state of knowledge regarding cryptococcosis in Transplant recipients and highlights areas where future investigations are needed to further optimize outcomes for these patients.
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central nervous system cryptococcosis in solid Organ Transplant recipients clinical relevance of abnormal neuroimaging findings
Transplantation, 2008Co-Authors: Nina Singh, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Krishan Lal Gupta, Ramon Del Busto, George John, Goran B Klintmalm, Jyoti SomaniAbstract:Background Prognostic implications of cryptococcal antigen and outcomes associated with CNS cryptococcal lesions in solid Organ Transplant (SOT) recipients have not been fully defined.
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pulmonary cryptococcosis in solid Organ Transplant recipients clinical relevance of serum cryptococcal antigen
Clinical Infectious Diseases, 2008Co-Authors: Nina Singh, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Krishan Lal Gupta, Ramon Del Busto, George John, Goran B Klintmalm, Jyoti SomaniAbstract:Background Role of serum cryptococcal antigen in the diagnosis and determinants of antigen positivity in solid Organ Transplant (SOT) recipients with pulmonary cryptococcosis has not been fully defined.
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an immune reconstitution syndrome like illness associated with cryptococcus neoformans infection in Organ Transplant recipients
Clinical Infectious Diseases, 2005Co-Authors: Patricia Muñoz, Nina Singh, Olivier Lortholary, Barbara D. Alexander, Krishan Lal Gupta, Kenneth Pursell, Goran B Klintmalm, George T John, Valentina StosorAbstract:Background. We describe an immune reconstitution syndrome (IRS)-like entity in the course of evolution of Cryptococcus neoformans infection in Organ Transplant recipients. Methods. The study population comprised a cohort of 83 consecutive Organ Transplant recipients with cryptococcosis who were observed for a median of 2 years in an international, multicenter study. Results. In 4 (4.8%) of the 83 patients, an IRS-like entity was observed a median of 5.5 weeks after the initiation of appropriate antifungal therapy. Worsening of clinical manifestations was documented, despite cultures being negative for C. neoformans. These patients were significantly more likely to have received tacrolimus, mycophenolate mofetil, and prednisone as the regimen of immunosuppressive therapy than were all other patients (P = .007). The proposed basis of this phenomenon is reversal of a predominantly Th2 response at the onset of infection to a Thi proinflammatory response as a result of receipt of effective antifungal therapy and a reduction in or cessation of immunosuppressive therapy. Conclusions. This study demonstrated that an IRS-like entity occurs in Organ Transplant recipients with C. neoformans infection. Furthermore, this entity may be misconstrued as a failure of therapy. Immunomodulatory agents may have a role as adjunctive therapy in such cases.
Olivier Lortholary - One of the best experts on this subject based on the ideXlab platform.
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invasive fungal infections in solid Organ Transplant recipients
Clinical Microbiology and Infection, 2014Co-Authors: Joan Gavalda, Patricia Muñoz, Olivier Lortholary, Yolanda Meije, Jesus Fortun, Emmanuel Roilides, F Saliba, Paolo Grossi, Manuel CuencaestrellaAbstract:Solid Organ Transplant (SOT) recipients have a significant risk of invasive fungal diseases (IFD) caused mainly by Candida spp. and Aspergillus spp. Candida spp. is the most frequent agent of IFD in the Transplant recipient. The absence of clinical trials and the epidemiological differences in IFD in different Transplant programmes mean that there are no definitive recommendations for the diagnosis, treatment and prevention of IFD in SOT, so most of the evidence must be based on clinical experience.
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cutaneous cryptococcosis in solid Organ Transplant recipients
Medical Mycology, 2010Co-Authors: Jyoti Somani, Graeme N. Forrest, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Hsinyun Sun, Marshall G Lyon, Krishan Lal GuptaAbstract:Clinical manifestations, treatment, and outcomes of cutaneous cryptococcosis in solid Organ Transplant (SOT) recipients are not fully defined. In a prospective cohort comprising 146 SOT recipients with cryptococcosis, we describe the presentation, antifungal therapy, and outcome of cutaneous cryptococcal disease. Cutaneous cryptococcosis was documented in 26/146 (17.8%) of the patients and manifested as nodular/mass (34.8%), maculopapule (30.4%), ulcer/pustule/abscess (30.4%), and cellulitis (30.4%) with 65.2% of the skin lesions occurred in the lower extremities. Localized disease developed in 30.8% (8/26), and disseminated disease in 69.2% (18/26) with involvement of the central nervous system (88.9%, 16/18), lung (33.3%, 6/18), or fungemia (55.6%, 10/18). Fluconazole (37.5%) was employed most often for localized and lipid formulations of amphotericin B (61.1%) for disseminated disease. Overall mortality at 90 days was 15.4% (4/26) with 16.7% in disseminated and 12.5% in localized disease (P = 0.78). SO...
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lipid formulations of amphotericin b significantly improve outcome in solid Organ Transplant recipients with central nervous system cryptococcosis
Clinical Infectious Diseases, 2009Co-Authors: Hsinyun Sun, Jyoti Somani, Graeme N. Forrest, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Marshall G Lyon, Krishan Lal Gupta, Ramon Del BustoAbstract:Synergistic interactions were observed between CIs and antifungal agents against 53 (90%) of 59 Cryptococcus neoformans isolates from solid Organ Transplant recipients with cryptococcosis and may account for better outcomes in patients with cryptococcosis receiving these immunosuppressive agents.
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cryptococcosis in solid Organ Transplant recipients current state of the science
Clinical Infectious Diseases, 2008Co-Authors: Nina Singh, Francoise Dromer, Olivier Lortholary, John R. PerfectAbstract:Cryptococcosis remains a significant opportunistic infection in solid Organ Transplant recipients. Disease presentation and outcomes may be affected by, among other factors, the use of calcineurin inhibitor immunosuppressive agents. It is being increasingly recognized that rapid reversal of immunosuppression in Transplant recipients treated for cryptococcosis incurs the risk of immune reconstitution inflammatory syndrome, which resembles worsening disease or relapse. This review summarizes the current state of knowledge regarding cryptococcosis in Transplant recipients and highlights areas where future investigations are needed to further optimize outcomes for these patients.
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central nervous system cryptococcosis in solid Organ Transplant recipients clinical relevance of abnormal neuroimaging findings
Transplantation, 2008Co-Authors: Nina Singh, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Krishan Lal Gupta, Ramon Del Busto, George John, Goran B Klintmalm, Jyoti SomaniAbstract:Background Prognostic implications of cryptococcal antigen and outcomes associated with CNS cryptococcal lesions in solid Organ Transplant (SOT) recipients have not been fully defined.
Krishan Lal Gupta - One of the best experts on this subject based on the ideXlab platform.
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cutaneous cryptococcosis in solid Organ Transplant recipients
Medical Mycology, 2010Co-Authors: Jyoti Somani, Graeme N. Forrest, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Hsinyun Sun, Marshall G Lyon, Krishan Lal GuptaAbstract:Clinical manifestations, treatment, and outcomes of cutaneous cryptococcosis in solid Organ Transplant (SOT) recipients are not fully defined. In a prospective cohort comprising 146 SOT recipients with cryptococcosis, we describe the presentation, antifungal therapy, and outcome of cutaneous cryptococcal disease. Cutaneous cryptococcosis was documented in 26/146 (17.8%) of the patients and manifested as nodular/mass (34.8%), maculopapule (30.4%), ulcer/pustule/abscess (30.4%), and cellulitis (30.4%) with 65.2% of the skin lesions occurred in the lower extremities. Localized disease developed in 30.8% (8/26), and disseminated disease in 69.2% (18/26) with involvement of the central nervous system (88.9%, 16/18), lung (33.3%, 6/18), or fungemia (55.6%, 10/18). Fluconazole (37.5%) was employed most often for localized and lipid formulations of amphotericin B (61.1%) for disseminated disease. Overall mortality at 90 days was 15.4% (4/26) with 16.7% in disseminated and 12.5% in localized disease (P = 0.78). SO...
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lipid formulations of amphotericin b significantly improve outcome in solid Organ Transplant recipients with central nervous system cryptococcosis
Clinical Infectious Diseases, 2009Co-Authors: Hsinyun Sun, Jyoti Somani, Graeme N. Forrest, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Marshall G Lyon, Krishan Lal Gupta, Ramon Del BustoAbstract:Synergistic interactions were observed between CIs and antifungal agents against 53 (90%) of 59 Cryptococcus neoformans isolates from solid Organ Transplant recipients with cryptococcosis and may account for better outcomes in patients with cryptococcosis receiving these immunosuppressive agents.
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pulmonary zygomycosis in solid Organ Transplant recipients in the current era
American Journal of Transplantation, 2009Co-Authors: Hsinyun Sun, Patricia Muñoz, Graeme N. Forrest, Krishan Lal Gupta, J M Aguado, Hugo Bonatti, Nasia Safdar, George John, Kenneth Pursell, Rakesh PatelAbstract:Fifty-eight solid Organ Transplant recipients with zygomycosis were studied to assess the presentation, radiographic characteristics, risks for extra-pulmonary dissemination and mortality of pulmonary zygomycosis. Pulmonary zygomycosis was documented in 31 patients (53%) and developed a median of 5.5 months (interquartile range, 2-11 months) postTransplantation. In all, 74.2% (23/31) of the patients had zygomycosis limited to the lungs and 25.8% (8/31) had lung disease as part of disseminated zygomycosis; cutaneous/soft tissue (50%, 4/8) was the most common site of dissemination. Pulmonary disease presented most frequently as consolidation/mass lesions (29.0%), nodules (25.8%) and cavities (22.6%). Patients with disseminated disease were more likely to have Mycocladus corymbifer as the causative pathogen. The mortality rate at 90 days after the treatment was 45.2%. In summary, pulmonary zygomycosis is the most common manifestation in solid Organ Transplant recipients with zygomycosis, and disseminated disease often involves the cutaneous/soft tissue sites but not the brain.
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central nervous system cryptococcosis in solid Organ Transplant recipients clinical relevance of abnormal neuroimaging findings
Transplantation, 2008Co-Authors: Nina Singh, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Krishan Lal Gupta, Ramon Del Busto, George John, Goran B Klintmalm, Jyoti SomaniAbstract:Background Prognostic implications of cryptococcal antigen and outcomes associated with CNS cryptococcal lesions in solid Organ Transplant (SOT) recipients have not been fully defined.
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pulmonary cryptococcosis in solid Organ Transplant recipients clinical relevance of serum cryptococcal antigen
Clinical Infectious Diseases, 2008Co-Authors: Nina Singh, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Krishan Lal Gupta, Ramon Del Busto, George John, Goran B Klintmalm, Jyoti SomaniAbstract:Background Role of serum cryptococcal antigen in the diagnosis and determinants of antigen positivity in solid Organ Transplant (SOT) recipients with pulmonary cryptococcosis has not been fully defined.
Jyoti Somani - One of the best experts on this subject based on the ideXlab platform.
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cutaneous cryptococcosis in solid Organ Transplant recipients
Medical Mycology, 2010Co-Authors: Jyoti Somani, Graeme N. Forrest, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Hsinyun Sun, Marshall G Lyon, Krishan Lal GuptaAbstract:Clinical manifestations, treatment, and outcomes of cutaneous cryptococcosis in solid Organ Transplant (SOT) recipients are not fully defined. In a prospective cohort comprising 146 SOT recipients with cryptococcosis, we describe the presentation, antifungal therapy, and outcome of cutaneous cryptococcal disease. Cutaneous cryptococcosis was documented in 26/146 (17.8%) of the patients and manifested as nodular/mass (34.8%), maculopapule (30.4%), ulcer/pustule/abscess (30.4%), and cellulitis (30.4%) with 65.2% of the skin lesions occurred in the lower extremities. Localized disease developed in 30.8% (8/26), and disseminated disease in 69.2% (18/26) with involvement of the central nervous system (88.9%, 16/18), lung (33.3%, 6/18), or fungemia (55.6%, 10/18). Fluconazole (37.5%) was employed most often for localized and lipid formulations of amphotericin B (61.1%) for disseminated disease. Overall mortality at 90 days was 15.4% (4/26) with 16.7% in disseminated and 12.5% in localized disease (P = 0.78). SO...
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lipid formulations of amphotericin b significantly improve outcome in solid Organ Transplant recipients with central nervous system cryptococcosis
Clinical Infectious Diseases, 2009Co-Authors: Hsinyun Sun, Jyoti Somani, Graeme N. Forrest, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Marshall G Lyon, Krishan Lal Gupta, Ramon Del BustoAbstract:Synergistic interactions were observed between CIs and antifungal agents against 53 (90%) of 59 Cryptococcus neoformans isolates from solid Organ Transplant recipients with cryptococcosis and may account for better outcomes in patients with cryptococcosis receiving these immunosuppressive agents.
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central nervous system cryptococcosis in solid Organ Transplant recipients clinical relevance of abnormal neuroimaging findings
Transplantation, 2008Co-Authors: Nina Singh, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Krishan Lal Gupta, Ramon Del Busto, George John, Goran B Klintmalm, Jyoti SomaniAbstract:Background Prognostic implications of cryptococcal antigen and outcomes associated with CNS cryptococcal lesions in solid Organ Transplant (SOT) recipients have not been fully defined.
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pulmonary cryptococcosis in solid Organ Transplant recipients clinical relevance of serum cryptococcal antigen
Clinical Infectious Diseases, 2008Co-Authors: Nina Singh, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Krishan Lal Gupta, Ramon Del Busto, George John, Goran B Klintmalm, Jyoti SomaniAbstract:Background Role of serum cryptococcal antigen in the diagnosis and determinants of antigen positivity in solid Organ Transplant (SOT) recipients with pulmonary cryptococcosis has not been fully defined.
Barbara D. Alexander - One of the best experts on this subject based on the ideXlab platform.
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cutaneous cryptococcosis in solid Organ Transplant recipients
Medical Mycology, 2010Co-Authors: Jyoti Somani, Graeme N. Forrest, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Hsinyun Sun, Marshall G Lyon, Krishan Lal GuptaAbstract:Clinical manifestations, treatment, and outcomes of cutaneous cryptococcosis in solid Organ Transplant (SOT) recipients are not fully defined. In a prospective cohort comprising 146 SOT recipients with cryptococcosis, we describe the presentation, antifungal therapy, and outcome of cutaneous cryptococcal disease. Cutaneous cryptococcosis was documented in 26/146 (17.8%) of the patients and manifested as nodular/mass (34.8%), maculopapule (30.4%), ulcer/pustule/abscess (30.4%), and cellulitis (30.4%) with 65.2% of the skin lesions occurred in the lower extremities. Localized disease developed in 30.8% (8/26), and disseminated disease in 69.2% (18/26) with involvement of the central nervous system (88.9%, 16/18), lung (33.3%, 6/18), or fungemia (55.6%, 10/18). Fluconazole (37.5%) was employed most often for localized and lipid formulations of amphotericin B (61.1%) for disseminated disease. Overall mortality at 90 days was 15.4% (4/26) with 16.7% in disseminated and 12.5% in localized disease (P = 0.78). SO...
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invasive fungal infections among Organ Transplant recipients results of the Transplant associated infection surveillance network transnet
Clinical Infectious Diseases, 2010Co-Authors: Peter G Pappas, Barbara D. Alexander, David R Andes, Susan Hadley, Carol A Kauffman, Alison G Freifeld, Elias J Anaissie, Lisa M Brumble, Loreen A Herwaldt, James I ItoAbstract:Methods. The Transplant-Associated Infection Surveillance Network (TRANSNET) is a consortium of 23 US Transplant centers, including 15 that contributed to the Organ Transplant recipient dataset. We prospectively identified IFIs among Organ Transplant recipients from March, 2001 through March, 2006 at these sites. To explore trends, we calculated the 12-month cumulative incidence among 9 sequential cohorts. Results. During the surveillance period, 1208 IFIs were identified among 1063 Organ Transplant recipients. The most common IFIs were invasive candidiasis (53%), invasive aspergillosis (19%), cryptococcosis (8%), nonAspergillus molds (8%), endemic fungi (5%), and zygomycosis (2%). Median time to onset of candidiasis, aspergillosis, and cryptococcosis was 103, 184, and 575 days, respectively. Among a cohort of 16,808 patients who underwent Transplantation between March 2001 and September 2005 and were followed through March 2006, a total of 729 IFIs were reported among 633 persons. One-year cumulative incidences of the first IFI were 11.6%, 8.6%, 4.7%, 4.0%, 3.4%, and 1.3% for small bowel, lung, liver, heart, pancreas, and kidney Transplant recipients, respectively. One-year incidence was highest for invasive candidiasis (1.95%) and aspergillosis (0.65%). Trend analysis showed a slight increase in cumulative incidence from 2002 to 2005. Conclusions. We detected a slight increase in IFIs during the surveillance period. These data provide important insights into the timing and incidence of IFIs among Organ Transplant recipients, which can help to focus effective prevention and treatment strategies.
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lipid formulations of amphotericin b significantly improve outcome in solid Organ Transplant recipients with central nervous system cryptococcosis
Clinical Infectious Diseases, 2009Co-Authors: Hsinyun Sun, Jyoti Somani, Graeme N. Forrest, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Marshall G Lyon, Krishan Lal Gupta, Ramon Del BustoAbstract:Synergistic interactions were observed between CIs and antifungal agents against 53 (90%) of 59 Cryptococcus neoformans isolates from solid Organ Transplant recipients with cryptococcosis and may account for better outcomes in patients with cryptococcosis receiving these immunosuppressive agents.
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central nervous system cryptococcosis in solid Organ Transplant recipients clinical relevance of abnormal neuroimaging findings
Transplantation, 2008Co-Authors: Nina Singh, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Krishan Lal Gupta, Ramon Del Busto, George John, Goran B Klintmalm, Jyoti SomaniAbstract:Background Prognostic implications of cryptococcal antigen and outcomes associated with CNS cryptococcal lesions in solid Organ Transplant (SOT) recipients have not been fully defined.
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pulmonary cryptococcosis in solid Organ Transplant recipients clinical relevance of serum cryptococcal antigen
Clinical Infectious Diseases, 2008Co-Authors: Nina Singh, Francoise Dromer, Olivier Lortholary, Barbara D. Alexander, Krishan Lal Gupta, Ramon Del Busto, George John, Goran B Klintmalm, Jyoti SomaniAbstract:Background Role of serum cryptococcal antigen in the diagnosis and determinants of antigen positivity in solid Organ Transplant (SOT) recipients with pulmonary cryptococcosis has not been fully defined.
