Cryptococcosis, a life-threatening mycosis caused mainly by Cryptococcus neoformans, appears to be distinctly rare in hematopoietic stem cell transplant (HSCT) recipients. When it occurs, this fungal infection is a major limitation for a successful transplant. This review comprehensively analyses 24 cases, reported in the literature, of patients with haematological malignancies including leukemias, multiple myeloma, and lymphomas, as indication for HSCT, who presented with cryptococcosis after transplantation. Of the 24 cases, 11 each occurred in patients receiving allogeneic and autologous stem cell transplants, from bone marrow, peripheral blood, and umbilical cord blood. HSCT recipients were slightly more often male, and the age of the patients ranged from 12 to 74 years. Antifungal prophylaxis was reported in most cases. Clinical manifestations of cryptococcal disease included more frequently central nervous system involvement followed by fungaemia, disseminated infection, pulmonary cryptococcosis, cerebellitis, and diarrhea. Diagnosis differed depending on the clinical presentation but habitually included cryptococcal antigen assay, India ink, and culture. Notably, not only C. neoformans but also C. albidus, C. terreus, C. laurentii, and C. adeliensis were identified as the causal species, the last two including strains resistant to fluconazole. Amphotericin B, alone or in combination, was the most common antifungal drug used for the treatment of cryptococcosis in HSCT recipients. Due to the small number of cases, it was not possible to establish if mortality rate, which was the same as survival rate, depends on the effect of the immunosuppressive regimen, the site of cryptococcal infection, and/or the antifungal therapy used to control the mycosis. Although uncommon, the recognition of cryptococcal disease in stem cell transplant is essential for a timely and adequate treatment, improved prognosis, reduced morbidity and mortality, and successful transplantation.

中文翻译：

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造血干细胞移植受者隐球菌病：罕见的演示保证识别。

隐球菌病，一种主要由新生隐球菌引起的威胁生命的真菌病在造血干细胞移植（HSCT）受体中似乎极为罕见。当它发生时，这种真菌感染是成功移植的主要限制。这篇综述全面分析了文献中报道的24例血液系统恶性肿瘤患者，包括白血病，多发性骨髓瘤和淋巴瘤，作为HSCT的指征，这些患者在移植后出现隐球菌病。在这24例病例中，有11例发生在接受来自骨髓，外周血和脐带血的同种异体和自体干细胞移植的患者中。HSCT接受者多为男性，患者年龄为12至74岁。在大多数情况下都报告了抗真菌药物的预防。隐球菌病的临床表现包括更频繁的中枢神经系统受累，随后是真菌血症，播散性感染，肺隐球菌病，小脑炎和腹泻。诊断因临床表现而异，但习惯上包括隐球菌抗原测定，印度墨水和培养物。值得注意的是，不仅新型隐球菌也C.球酵母，C.土曲霉，C.罗伦和C. adeliensis被确定为病因物种，后两个包括对氟康唑耐药的菌株。两性霉素B单独或联合使用是在HSCT受体中用于治疗隐球菌病的最常见抗真菌药。由于病例数少，无法确定与存活率相同的死亡率是否取决于免疫抑制方案，隐球菌感染部位和/或用于控制病情的抗真菌治疗的效果。真菌病。尽管不常见，但对干细胞移植中隐球菌病的认识对于及时，适当的治疗，改善预后，降低发病率和死亡率以及成功进行移植至关重要。