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Project title:
Cryptococcus neoformans Infection in Organ Transplant Recipients: Impact of Immunosuppressive Agent Resistance and Virulence Factors on Tissue Tropism and Outcome.
Funding Agency:
NIH
Project status:
open to enrollment
Principal Investigator:
Nina Singh, MD
Protocol summary:
To determine if there are differences in the incidence, clinical manifestations, and outcome of cryptococcosis in transplant recipients receiving tacrolimus, cyclosporine or rapamycin and to assess if cerebrospinal fluid levels of immunosuppressive agents correlate with CNS infection.
To determine if C. neoformans isolates in transplant recipients represent breakthrough infections with immunosuppressive agent resistant mutants and to compare the clinical manifestations, response to therapy, and outcome of mutant versus the non-mutant cryptococcal isolates.
To determine whether the following characteristics of C. neoformans correlate with clinical manifestations, and outcome: capsule size, serotype, melanin synthesis, thermal susceptibility, urease and phospholipase production.
To determine if C. neoformans represents reactivation of a latently harbored infection or new acquisition of infection and to discern if certain Western blot band patterns are more likely to reactivate than others.
Secondary Objective:
- To determine the clinical (e.g., demographic variables, time of onset, rejection, augmented immunosuppression, pre-existent renal dysfunction, site of involvement, prior cytomegalovirus infection) and laboratory variables (e.g., positive blood cultures, CSF opening pressure, serum and CSF cryptococcal antigen titer) predictive of patient outcome in transplant recipients with C. neoformans infection.
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