Cryptococcosis In Solid Organ Transplantation
Publication Date: April 1, 2019
Last Updated: April 5, 2022
DIAGNOSTIC STRATEGIES
Patients with suspected or proven cryptococcosis should have a thorough evaluation of extrapulmonary disease, including lumbar puncture, blood, and other relevant tissue cultures. (Moderate, Strong)
317067
Cryptococcal antigen testing from blood and CSF should be performed preferably using the lateral flow assay over latex agglutination assay. (Moderate, Strong)
317067
All sources should be cultured for and identified at the species level (C. neoformans vs C. gattii). (Moderate, Weak)
317067
Susceptibility testing is recommended for patients who fail primary therapy, who have relapse of disease, who develop cryptococcosis with prior antifungal exposure (ie, fluconazole prophylaxis), or in patients with C. gattii genotypes that have been associated with elevated fluconazole MICs. (High, Strong)
317067
Imaging of lungs and CNS should be performed in patients with suspected or proven cryptococcosis. (High, Strong)
317067
TREATMENT
A lumbar puncture should be performed for diagnosis of CNS disease and evaluation and management of intracranial pressure, (High, Strong)
317067
A lipid formulation of amphotericin B plus 5‐flucytosine is preferred as induction therapy for CNS disease, disseminated disease, or moderate‐to‐severe pulmonary disease. (High, Strong)
317067
Fluconazole is preferred for consolidation and maintenance therapy for CNS disease. (Moderate, Strong)
317067
Fluconazole is the preferred therapy for asymptomatic or mild‐to-moderate pulmonary disease. (Moderate, Strong)
317067
Newer triazoles should be reserved as alternative agents when fluconazole cannot be used or for patients with isolates that may be resistant to fluconazole. (Low, Weak)
317067
Reduction of immunosuppression should be performed at time of diagnosis of cryptococcosis. (Low, Weak)
317067
IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME
Serial lumbar punctures should be performed for the manage ment of elevated ICP. (Moderate, Strong)
317067
Temporary or permanent CSF drainage should be considered for in patients where serial lumbar punctures fail to normalize ICP. (Low, Strong)
317067
Immune reconstitution syndrome can occur within weeks of start of antifungal therapy and reduced immunosuppression. Exclusion of clinical failure with repeat cultures is warranted before initiating corticosteroid treatment. (Low, Weak)
317067
Title
Cryptococcosis In Solid Organ Transplantation
Authoring Organization
American Society of Transplantation
Publication Month/Year
April 1, 2019
Last Updated Month/Year
January 30, 2024
External Publication Status
Published
Country of Publication
US
Document Objectives
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of cryptococcosis in the pre‐ and post‐transplant period.
Target Patient Population
Solid organ transplant patients
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Operating and recovery room, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Prevention, Management
Diseases/Conditions (MeSH)
D019072 - Antibiotic Prophylaxis, D014180 - Transplantation, D000898 - Antibiosis, D000935 - Antifungal Agents, D016377 - Organ Transplantation, D003453 - Cryptococcosis
Keywords
antifungal, antibiotic, solid organ transplant, infections
Source Citation
Baddley, JW, Forrest, GN; on behalf of the AST Infectious Diseases Community of Practice. Cryptococcosis in solid organ transplantation—Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019; 33:e13543.