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Cryptococcal meningitis after liver transplantation
1University of Pittsburgh, Pittsburgh Transplantation Institute, Pennsylvania 15213, USA.
Abstract:
We present our experience with 10 liver transplant recipients in whom cryptococcal meningitis developed after liver transplantation. Disease developed a median period of 3.5 months (range, 2-36 months) after transplantation and patients were diagnosed a median period of 9 days (range, 2-90 days) after initial symptoms. Headache, fever, and mental status changes were the most frequent clinical presentations, while meningismus was found in only 30% of patients. Cerebrospinal fluid analysis was diagnostic in all cases. All patients were treated with amphotericin B and flucytosine. Immunosuppression was either decreased or discontinued during therapy. Five patients died, four as a direct result of cryptococcal infection and one as a result of chronic rejection. Three patients had long-term survival without any sequelae. One long-term survivor suffered blindness consequent to the disease. We conclude that cryptococcal meningitis is a rare complication in liver transplant recipients (0.25%), and has a high mortality rate (50%). Early recognition, combination antifungal therapy, and decrease or discontinuation of immunosuppression are important for cure. No relapse has been seen in surviving patients.
Insights
Cryptococcal meningitis is a rare but serious complication in liver transplant recipients. Early diagnosis and combination antifungal treatment with reduced immunosuppression are crucial for survival.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Neurology
Background:
- Liver transplant recipients are immunocompromised, increasing susceptibility to opportunistic infections.
- Cryptococcal meningitis is a significant cause of morbidity and mortality in this population.
Purpose of the Study:
- To describe the clinical experience with cryptococcal meningitis in liver transplant recipients.
- To evaluate treatment outcomes and identify factors influencing survival.
Main Methods:
- Retrospective case series of 10 liver transplant recipients diagnosed with cryptococcal meningitis.
- Analysis of clinical presentation, diagnostic methods, treatment regimens (amphotericin B and flucytosine), and outcomes.
Main Results:
- Cryptococcal meningitis occurred a median of 3.5 months post-transplant.
- Headache, fever, and altered mental status were common; meningismus was infrequent.
- Cerebrospinal fluid analysis was diagnostic in all cases.
- The mortality rate was 50%, with 4 deaths directly from infection.
- Long-term sequelae included blindness in one survivor.
Conclusions:
- Cryptococcal meningitis is a rare (0.25%) but highly fatal complication in liver transplant recipients.
- Early recognition, prompt combination antifungal therapy, and immunosuppression adjustment are vital for successful management.
- No relapses were observed in surviving patients.