@article {1111,
	title = {Identifying predictors of central nervous system disease in solid organ transplant recipients with cryptococcosis},
	journal = {Transplantation},
	volume = {89},
	year = {2010},
	note = {Osawa, Ryosuke Alexander, Barbara D Lortholary, Olivier Dromer, Francoise Forrest, Graeme N Lyon, G Marshall Somani, Jyoti Gupta, Krishan L Del Busto, Ramon Pruett, Timothy L Sifri, Costi D Limaye, Ajit P John, George T Klintmalm, Goran B Pursell, Kenneth Stosor, Valentina Morris, Michele I Dowdy, Lorraine A Munoz, Patricia Kalil, Andre C Garcia-Diaz, Julia Orloff, Susan House, Andrew A Houston, Sally Wray, Dannah Huprikar, Shirish Johnson, Leonard B Humar, Atul Razonable, Raymund R Fisher, Robert A Husain, Shahid Wagener, Marilyn M Singh, Nina R01 AI 054719-01/AI/NIAID NIH HHS/United States Multicenter Study Research Support, N.I.H., Extramural United States Transplantation Transplantation. 2010 Jan 15;89(1):69-74.},
	month = {Jan 15},
	pages = {69 - 74},
	edition = {40190},
	abstract = {BACKGROUND: Cerebrospinal fluid (CSF) analysis is often deferred in patients with cryptococcal disease, particularly in the absence of neurologic manifestations. We sought to determine whether a subset of solid organ transplant (SOT) recipients with high likelihood of central nervous system (CNS) disease could be identified in whom CSF analysis must be performed. METHODS: Patients comprised a multicenter cohort of SOT recipients with cryptococcosis. RESULTS: Of 129 (88\%) of 146 SOT recipients with cryptococcosis who underwent CSF analysis, 80 (62\%) had CNS disease. In the overall study population, abnormal mental status, time to onset of cryptococcosis more than 24 months posttransplantation (late-onset disease), serum cryptococcal antigen titer more than 1:64, and fungemia were independently associated with an increased risk of CNS disease. Of patients with abnormal mental status, 95\% had CNS cryptococcosis. When only patients with normal mental status were considered, three predictors (serum antigen titer >1:64, fungemia, and late-onset disease) independently identified patients with CNS cryptococcosis; the risk of CNS disease was 14\% if none, 39\% if one, and 94\% if two of the aforementioned predictors existed (chi for trend P<0.001). CONCLUSIONS: CSF analysis should be strongly considered in SOT recipients with cryptococcosis who have late-onset disease, fungemia, or serum cryptococcal antigen titer more than 1:64 even in the presence of normal mental status.},
	keywords = {Adult, Antigens, Fungal / blood, Central Nervous System Diseases / *epidemiology, Chi-Square Distribution, Cohort Studies, Cryptococcosis / complications / *epidemiology, Drug Therapy, Combination, Female, Humans, Immunosuppressive Agents / therapeutic use, Likelihood Functions, Male, Middle Aged, Organ Transplantation / *adverse effects, Postoperative Complications / epidemiology / microbiology, Predictive Value of Tests, Prospective Studies, Regression Analysis},
	issn = {1534-6080 (Electronic) 0041-1337 (Linking)},
	doi = {10.1097/TP.0b013e3181bcda41 00007890-201001150-00009 [pii]},
	author = {Osawa,R. and Alexander,B. D. and Lortholary,O. and Dromer,F. and Forrest,G. N. and Lyon,G. M. and Somani,J. and Gupta,K. L. and del Busto,R. and Pruett,T. L. and Sifri,C. D. and Limaye,A. P. and John,G. T. and Klintmalm,G. B. and Pursell,K. and Stosor,V. and Morris,M. I. and Dowdy,L. A. and Munoz,P. and Kalil,A. C. and Garcia-Diaz,J. and Orloff,S. and House,A. A. and Houston,S. and Wray,D. and Huprikar,S. and Johnson,L. B. and Humar,A. and Razonable,R. R. and Fisher,R. A. and Husain,S. and Wagener,M. M. and Singh,N.}
}
