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Cryptococcosis is the third most common invasive fungal infection among solid organ transplant recipients but has been reported very rarely in hematopoietic stem cell transplant recipients. Pulmonary cryptococcal disease is the most common clinical presentation, and the central nervous system involvement is the most common extrapulmonary site. Diagnosis is confirmed by isolation of the fungus from culture samples and measuring cryptococcal antigen in various body fluids including serum and CSF; histologic evidence of dimorphic fungi in tissue samples may provide a clue to the etiology and in most instances is not required to confirm the diagnosis. Depending on disease severity and extent of infection, treatment consists of lipid formulations of amphotericin B plus flucytosine, and/or fluconazole. Reduction in immunosuppression should also be attempted in transplant recipients with acute cryptococcal infection. However, attempts in rapid reduction of immune suppression may theoretically place patients at risk for cryptococcal immune reconstitution inflammatory syndrome. In this chapter, a comprehensive review of cryptococcal disease is presented in context of patients undergoing solid organ and hematopoietic stem cell transplantation.

DOI: 10.1007/978-1-4939-9034-4_35