648. Geographic Differences in Disease Expression of Cryptococcosis in Solid Organ Transplant (SOT) Recipients in the United States (US)
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Whether there are geographic differences in clinical presentation of cryptococcosis in SOT recipients in the US is not known.

Methods: Patients comprised a prospective cohort of 120 SOT recipients with cryptococcosis from 16 transplant centers from 5 regions of the US (Southern, South Atlantic, Mid Atlantic, Midwestern, and Northwestern). All patients fulfilled the EORTC/MSG criteria for cryptococcosis.

Results: Central nervous system (CNS), 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. In univariable analysis, 26% of the patients from the Southern versus 12% from the rest of the regions had cutaneous cryptococccosis (OR 2.5, 95% CI 0.82-7.6, P=0.092). With the exception of a lower frequency of renal failure at baseline in patients from the Southern region (P=0.025), none of the other variables (age, type of transplant, calcineurin-inhibitor agent or prednisone use, prior rejection, time to onset post-transplant, cytomegalovirus infection, retransplantation, frequency of CNS or disseminated cryptococcosis) differed significantly. 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 disease (OR 3.8, 95% CI 1.1-14, P=0.045).

Conclusion: Post-transplant cryptococcosis is preferentially more likely to present with cutaneous disease in the Southern compared with the rest of the US. This increased predilection for cutaneous cryptocococcosis could not be explained on the basis of differences in immunosuppression or type of transplant and may be related to strain related variations in dermatotropism or other characteristics of the yeast.

Subject Category: M. Mycology including clinical and basic studies of fungal infections

Ryosuke Osawa, MD , Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA
Barbara D. Alexander, MD, FIDSA , Division of Infectious Diseases and Internal Medicine, Duke University, Durham, NC
Nina Singh, MD , VA Medical Center, Pittsburgh, PA


R. Osawa, None

B. D. Alexander, Yes
bioMeriuux: Scientific Advisor, Consulting fee
Pfizer, Astellas: Grant Investigator, Research grant

N. Singh, Yes
Pfizer: Grant Investigator, Research grant

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