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Cryptococcosis is a significant opportunistic infection affecting 2.8-5% of the transplant patients. Mortality ranges from 20- 42%; patients with central nervous system infection has moratality rate of about 50%. In this study I would like to describe the various clinical presentation, risk factors ,management and prognosis .
• Confirmed cases of cryptococcosis among renal transplant recipients between 2009 to 2022 were included in this study .
• Presenting features ,risk factors, management strategies and graft survival were retrospectively analyzed .
Out of 1300 renal transplants recipients 6 patients diagnosed to have cryptococcosis (M:F 4:2) .
Prevalence of cryptococcal infection in our centre 0.46% .The average time to infection following renal transplantation was around 3.4 years in our study .
Among transplant recipients, induction agents used were thymoglobin in 4 recipients and basiliximab for 2 recipients.
Presenting features were weight loss, cough, loss of appetite, headache and signs of meningitis.
Diagnostic modalities included histopathological demonstration of the organism in cases of lymph node cryptococcosis, bronchoalveolar lavage, cerebrospinal fluid analysis. Distribution of infections were as follows pulmonary cryptococcosis (n=1),cryptococcal meningitis (n=1), cryptococcal lymphadenitis (n=1), cutaneous cryptococcosis(n=1) ,disseminated cryptococcosis (n=1) and cryptococcemia (n=1) .Treatment modalities included liposomal amphotericin B, fluconazole and surgical treatment includes lobectomy & incision and drainage . All transplant patients had elevated TAC level and temporary renal function impairment during the treatment time ,which were managed with dose adjustments. On 1 year followup majority of transplant patient had 50 % mild to moderate graft dysfunction.One patient with allograft failure was on hemodialysis underwent renal retransplantation after successful one year treatment. All patients had resolution.
Cryptococcal infection may affect major organ system .Since this infection is having high mortality rate ,early diagnosis and prolonged treatment is crucial in survival. Cryptococcosis should be considered in differential diagnosis when subtle neurological symptoms appear in renal transplant recipients