Cryptococcosis in kidney transplant recipients: Current understanding and practices

P. Meena, V. Bhargava, Kulwant Singh, Jasmine sethi, Aniketh Prabhakar, Sandip Panda
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Abstract

Cryptococcosis is the third most commonly occurring invasive fungal disease in solid organ transplant recipients (SOT). It is caused by encapsulated yeast, Cryptococcus species, predominantly Cryptococcus neoformans and Cryptococcus gattii. Though kidney transplant recipients are at the lowest risk of cryptococcosis when compared to other solid organ transplant recipients such as lung, liver or heart, still this opportunistic infection causes significant morbidity and mortality in this subset of patients. Mortality rates with cryptococcosis range from 10%-25%, while it can be as high as 50% in SOT recipients with central nervous system involvement. The main aim of diagnosis is to find out if there is any involvement of the central nervous system in disseminated disease or whether there is only localized pulmonary involvement as it has implications for both prognostication and treatment. Detection of cryptococcal antigen (CrAg) in cerebrospinal fluid or plasma is a highly recommended test as it is more sensitive and specific than India ink and fungal cultures. The CrAg lateral flow assay is the single point of care test that can rapidly detect cryptococcal polysaccharide capsule. Treatment of cryptococcosis is challenging in kidney transplant recipients. Apart from the reduction or optimization of immunosuppression, lipid formulations of amphotericin B are preferred as induction antifungal agents. Consolidation and maintenance are done with fluconazole; carefully monitoring its interactions with calcineurin inhibitors. This review further discusses in depth the evolving developments in the epidemiology, pathogenesis, diagnostic assays, and management approach of cryptococcosis in kidney transplant recipients.
肾移植受者中的隐球菌病:当前的认识和实践
隐球菌病是实体器官移植受者(SOT)中第三大常见的侵袭性真菌疾病。它是由隐球菌属包裹酵母引起的,主要是新生隐球菌和加特隐球菌。虽然与肺、肝或心脏等其他实体器官移植受者相比,肾移植受者患隐球菌病的风险最低,但这种机会性感染仍会给这部分患者带来严重的发病率和死亡率。隐球菌病的死亡率在10%-25%之间,而在中枢神经系统受累的SOT受者中,死亡率可高达50%。诊断的主要目的是查明播散性疾病是否累及中枢神经系统,还是仅有局部肺部受累,因为这对预后和治疗都有影响。检测脑脊液或血浆中的隐球菌抗原(CrAg)是非常值得推荐的检测方法,因为它比印度墨水和真菌培养更敏感、更特异。CrAg 侧流试验是唯一能快速检测隐球菌多糖胶囊的护理检测点。肾移植受者隐球菌病的治疗具有挑战性。除了减少或优化免疫抑制外,两性霉素 B 的脂质制剂是首选的诱导抗真菌药物。氟康唑可用于巩固和维持治疗,但需谨慎监测其与钙神经蛋白抑制剂的相互作用。本综述进一步深入探讨了肾移植受者隐球菌病的流行病学、发病机制、诊断方法和管理方法的发展变化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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