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Cryptococcus neoformans primarily affects immunocompromised individuals and the central nervous system (CNS) is the most common site of dissemination. Entrapped temporal horn syndrome (ETH) remains a rare CNS manifestation and has not previously been described in solid organ transplant recipients. Here, we present a case of ETH in a 55-year-old woman with history of renal transplant and prior treated Cryptococcal meningitis.

Maribavir (MBV) is an antiviral agent with potent activity against cytomegalovirus (CMV), acting on the viral UL97-encoded protein kinase, thereby inhibiting vital steps in viral replication. Phase II and III clinical trials have demonstrated a favorable safety profile of MBV. MBV has been studied for both the prevention and treatment of CMV with mixed effectiveness; however, it has been shown to improve outcomes in treating refractory/resistant CMV infection compared with other available CMV antivirals. Given it was FDA-approved only recently, real-world data on the use of this agent is limited. This article will review the in vitro and pharmacologic data of MBV and the evidence supporting safety and efficacy in managing CMV infection in transplant recipients. Article highlights Cytomegalovirus (CMV) is a significant cause of morbidity and mortality in patients following solid organ or stem cell transplantation. Treatment of CMV with existing agents such as (val)ganciclovir, foscarnet, or cidofovir may lead to significant drug toxicities, including cytopenias, electrolyte abnormalities and acute kidney injury. MBV is a benzimidazole riboside that competitively inhibits a CMV protein kinase encoded by UL97, preventing the phosphorylation of proteins vital to CMV viral replication. MBV demonstrated superiority for treating post-transplant refractory CMV infection (with or without resistance) compared with investigator-assigned therapy, gaining U.S. FDA approval for this indication. MBV has a favorable safety profile, with less leukopenia and neutropenia than (val)ganciclovir and less acute kidney injury than foscarnet. Common adverse effects of MBV in clinical trials have included nausea and dysgeusia. Clinical trials have also demonstrated that relapsed CMV viremia–including the development of resistance while on MBV–is common. The use of MBV for other indications besides refractory CMV infection (e.g., prophylaxis, pre-emptive therapy) has demonstrated variable results in randomized clinical trials. While MBV remains a valuable addition to the management of CMV, further study is needed to identify what role, if any, the drug has beyond the treatment of refractory CMV infections in transplant patients. [ABSTRACT FROM AUTHOR]

Transplant infectious disease (TID) clinicians are integral to the pre‐transplantation evaluation. Pre‐transplant evaluations allow clinicians to assess risk factors for latent infections and relevant exposures to potential pathogens, address immunizations, and optimize patients' health and understanding of life after transplant. However, there is not a standardized approach to the pre‐transplant evaluation. This article reviews the details of performing successful pre‐transplant evaluations, including updated recommendations on available vaccines and contemporary opinions on marijuana use. This resource can be used for teaching with trainees or for early career TID clinicians. [ABSTRACT FROM AUTHOR]

Background Pneumocystis jirovecii is an opportunistic fungus that causes Pneumocystis pneumonia (PCP) in immunocompromised hosts. Over an 11-month period, we observed a rise in cases of PCP among kidney-transplant recipients (KTR), prompting an outbreak investigation. Methods Clinical and epidemiologic data were collected for KTR diagnosed with PCP between July 2019 and May 2020. Pneumocystis strain typing was performed using restriction fragment length polymorphism analyses and multilocus sequence typing in combination with next-generation sequencing. A transmission map was drawn, and a case-control analysis was performed to determine risk factors associated with PCP. Results Nineteen cases of PCP in KTR were diagnosed at a median of 79 months post-transplantation; 8 received monthly belatacept infusions. Baseline characteristics were similar for KTR on belatacept versus other regimens; the number of clinic visits was numerically higher for the belatacept group during the study period (median 7.5 vs 3). Molecular typing of respiratory specimens from 9 patients revealed coinfection with up to 7 P. jirovecii strains per patient. A transmission map suggested multiple clusters of interhuman transmission. In a case-control univariate analysis, belatacept, lower absolute lymphocyte count, non-White race, and more transplant clinic visits were associated with an increased risk of PCP. In multivariate and prediction power estimate analyses, frequent clinic visits was the strongest risk factor for PCP. Conclusions Increased clinic exposure appeared to facilitate multiple clusters of nosocomial PCP transmission among KTR. Belatacept was a risk factor for PCP, possibly by increasing clinic exposure through the need for frequent visits for monthly infusions. [ABSTRACT FROM AUTHOR]

Infusion reactions (tachycardia, hypertension, fever, etc.) associated with liposomal amphotericin B are common. Animal models have found complement activation responsible, yet the pathophysiology has not been evaluated in human patients. We performed a prospective observational study and found complement activation-related pseudoallergy (CARPA) responsible in those with infusion reactions., Competing Interests: G.R.T. has received research support and consulting for Astellas, Basilea, Cidara, F2G, GSK, Mundipharma, Melinta, and Scynexis. G.R.T. has served on the DSMB for Pfizer.