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, Leonard B. Johnson, Raymund R. Razonable, Robert A. Fisher, Marilyn M. Wagener, Shahid Husain, Nina Singh
Ann Transplant 2010; 15(4): 77-83
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, Skin Diseases, Solid Organ Transplantation, Geography, epidemiology