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Background: Whether donor (D+) or recipient (R+) cytomegalovirus (CMV) seropositivity is associated with functional impairment in liver transplant recipients is not known. Methods: Patients included adult liver transplant recipients in the Organ Procurement and Transplantation Network database transplanted over a five-year period from 1 January 2014–31 December 2018. Functional status in the database was assessed using Karnofsky performance scale. A logistic regression model that controlled for potential confounders was used to examine the association of CMV serostatus and functional status. Variables significantly associated with functional status (p< 0.05) were then used to develop propensity score and propensity score matched analysis was conducted where each patient was compared with a matched-control with the same propensity score. Results: Among 30,267 adult liver transplant recipients, D+ or R+ patients had significantly lower functional status at last follow-up than the D-R- cohort (OR 0.88, 95% CI 0.80–0.96, p = 0.007). In propensity score matched model, D+ or R+ patients had significantly lower functional status than matched-controls (p = 0.009). D+ or R+ CMV serostatus (p = 0.018) and low functional level (p< 0.001) were also independently associated with infections as cause-of-death. Conclusions: D+ or R+ liver transplant recipients had lower functional status and higher risk of deaths due to infections. Future studies are warranted to examine the mechanistic basis of these findings in the setting of transplantation.
Nina Singh; Marilyn Wagener. Cytomegalovirus Serostatus and Functional Impairment in Liver Transplant Recipients in the Current Era. Viruses 2021, 13, 1519 .
AMA StyleNina Singh, Marilyn Wagener. Cytomegalovirus Serostatus and Functional Impairment in Liver Transplant Recipients in the Current Era. Viruses. 2021; 13 (8):1519.
Chicago/Turabian StyleNina Singh; Marilyn Wagener. 2021. "Cytomegalovirus Serostatus and Functional Impairment in Liver Transplant Recipients in the Current Era." Viruses 13, no. 8: 1519.
CMV viremia is a contributor to poor outcomes in critically ill patients with sepsis. To assess the expression levels of genes encoding inflammasome-related proteins in the development of CMV viremia in critically ill patients with sepsis. A cohort of CMV-seropositive critically ill patients with sepsis due to bloodstream infection underwent weekly testing for CMV viremia. Blood samples to evaluate mRNA levels of genes encoding CASP1, ASC, NLRP1, NLRP3, and NLRP12 were collected at the time of enrollment. Clinical outcomes were assessed at 30 days or until death/discharge from ICU. CMV viremia was documented in 27.5% (8/29) of the patients, a median of 7 days after the onset of bacteremia. Patients with sepsis who developed CMV viremia had higher CASP1 although this was not statistically significant (relative mean 3.6 vs 1.8, p = 0.13). Development of high grade CMV viremia however, was significantly associated with CASP1; septic patients who developed high grade CMV viremia had significantly higher CASP1than all other patients (relative mean 5.5 vs 1.8, p = 0.016). These data document possible involvement of inflammasome in the pathogenesis of CMV. Regulating the host immune response by agents that target these genes may have implications for improving CMV-related outcomes in these patients.
Nina Singh; Makoto Inoue; Ryosuke Osawa; Marilyn M. Wagener; Mari L. Shinohara. Inflammasome expression and cytomegalovirus viremia in critically ill patients with sepsis. Journal of Clinical Virology 2017, 93, 8 -14.
AMA StyleNina Singh, Makoto Inoue, Ryosuke Osawa, Marilyn M. Wagener, Mari L. Shinohara. Inflammasome expression and cytomegalovirus viremia in critically ill patients with sepsis. Journal of Clinical Virology. 2017; 93 ():8-14.
Chicago/Turabian StyleNina Singh; Makoto Inoue; Ryosuke Osawa; Marilyn M. Wagener; Mari L. Shinohara. 2017. "Inflammasome expression and cytomegalovirus viremia in critically ill patients with sepsis." Journal of Clinical Virology 93, no. : 8-14.
Introduction: Opportunistic mycoses remain a significant complication in organ recipients. Areas covered: This review is an evidence-based presentation of current state-of-knowledge and our perspective on recent developments in the field Expert commentary: Invasive fungal infections are associated with reduced allograft and patient survival, increase in healthcare resource utilization, and newly appreciated but largely unrecognized immunologic sequelae, such as immune reconstitution syndrome. Given adverse outcomes associated with established infections, prophylaxis is a widely used strategy for the prevention of these infections. Currently available biomarkers that detect circulating fungal cell wall constituents i.e., galactomannan and 1, 3-β-D-glucan have not proven to be beneficial as screening tools for employing targeted prophylaxis or as diagnostic assays in this patient population. However, subsets of patients at risk for opportunistic fungal infections can be identified based on clinically identifiable characteristics or events. Preventive strategies targeted towards these patients are a rational approach for optimizing outcomes.
Palash Samanta; Nina Singh. Complications of invasive mycoses in organ transplant recipients. Expert Review of Anti-infective Therapy 2016, 14, 1195 -1202.
AMA StylePalash Samanta, Nina Singh. Complications of invasive mycoses in organ transplant recipients. Expert Review of Anti-infective Therapy. 2016; 14 (12):1195-1202.
Chicago/Turabian StylePalash Samanta; Nina Singh. 2016. "Complications of invasive mycoses in organ transplant recipients." Expert Review of Anti-infective Therapy 14, no. 12: 1195-1202.
HHV-6 is a beta herpes virus that establishes latency after primary infection with most infections occurring in the childhood. Active HHV-6 infection occurs in 20–50 % of transplant recipients and is largely due to endogenous reactivation of the latent virus. Infection typically develops in the early posttransplant period. The most frequently observed clinical features of HHV-6 are febrile dermatosis and bone marrow suppression and less commonly encephalitis, interstitial pneumonitis, and hepatitis. HHV-6 also has immunomodulatory effects that may facilitate superinfections with other opportunistic infections, particularly CMV and fungal infections. Treatment of HHV-6 remains challenging. Based on in vitro and anecdotal data, ganciclovir, foscarnet, and cidofovir have been used clinically. The role of HHV-7 as a pathogen in transplant recipients is not fully defined. KSHV is the etiologic agent of Kaposi’s sarcoma (KS). The incidence of posttransplant KS varies widely and largely parallels the geographic seroprevalence of KSHV. Cutaneous lesions are most common; however, up to 40 % of transplant recipients may develop visceral disease. Reduction or withdrawal of immunosuppression remains the mainstay of the management of KS in transplant recipients.
Nina Singh. Human Herpesvirus-6, -7, and -8 After Solid Organ Transplantation. Transplant Infections 2016, 535 -545.
AMA StyleNina Singh. Human Herpesvirus-6, -7, and -8 After Solid Organ Transplantation. Transplant Infections. 2016; ():535-545.
Chicago/Turabian StyleNina Singh. 2016. "Human Herpesvirus-6, -7, and -8 After Solid Organ Transplantation." Transplant Infections , no. : 535-545.
Cryptococcus has emerged as a significant pathogen in immunocompromised patients. While the diagnostic testing and the antifungal treatment of cryptococcal infections have become firmly established in clinical practice, new developments and areas of ambiguity merit further consideration. These include the potential for donor transmission of Cryptococcus; cirrhosis-associated cryptococcosis, particularly during transplant candidacy; the utility of serum cryptococcal antigen testing of asymptomatic individuals in high-prevalence, poor-resource areas; pathogenesis and treatment of the immune reconstitution syndrome, specifically in relation to antiretroviral therapy and immunosuppressive medications; and new challenges posed by the emerging species of Cryptococcus gatti. In this article, we summarize the literature pertaining to these topics, focusing on recent progress.
Ghady Haidar; Nina Singh. Cryptococcus: Shedding New Light on an Inveterate Yeast. Journal of Fungi 2015, 1, 115 -129.
AMA StyleGhady Haidar, Nina Singh. Cryptococcus: Shedding New Light on an Inveterate Yeast. Journal of Fungi. 2015; 1 (2):115-129.
Chicago/Turabian StyleGhady Haidar; Nina Singh. 2015. "Cryptococcus: Shedding New Light on an Inveterate Yeast." Journal of Fungi 1, no. 2: 115-129.
Nina Singh. Immune recovery gone rogue: Microbe-associated immune reconstitution syndrome in neutropenic host. Journal of Infection 2015, 70, 563 -564.
AMA StyleNina Singh. Immune recovery gone rogue: Microbe-associated immune reconstitution syndrome in neutropenic host. Journal of Infection. 2015; 70 (6):563-564.
Chicago/Turabian StyleNina Singh. 2015. "Immune recovery gone rogue: Microbe-associated immune reconstitution syndrome in neutropenic host." Journal of Infection 70, no. 6: 563-564.
Whether nodular lesions have specific risk-factors or influence outcomes in lung transplant recipients with invasive aspergillosis, is not fully known. The study population consisted of 64 consecutive lung transplant recipients with proven or probable invasive aspergillosis. Nodules, with or without halo/air crescent-sign were considered nodular presentations. Outcomes assessed were response rate (successful versus unsuccessful outcome) and all-cause mortality at 12 weeks. Overall, 34 patients had nodular and 30 had non-nodular lesions. Presence of nodular lesions was less likely to be associated with renal failure at baseline (adjusted OR 0.21, 95% CI, 0.04-0.97, p = 0.047), CMV infection (adjusted OR 0.18, 95% CI 0.04-0.75, p = 0.019) and receipt of antifungal prophylaxis (adjusted OR 0.22, 95% CI, 0.06-0.88, p = 0.032). Successful outcome and mortality rates in the study patients were 64.0% (41/64) and 25.0% (16/64), respectively. Nodular aspergillosis was associated with significantly higher successful outcome (adjusted OR 3.35, 95% CI, 1.06-10.54, p = 0.039) and lower mortality at 12 weeks (adjusted OR 0.20, 0.05-0.78, p = 0.021). Lung transplant recipients with nodular lesions due to invasive aspergillosis had better outcomes than those without such lesions.
Nina Singh; Jose F. Suarez; Robin Avery; Cornelia Lass-Flörl; Christian Geltner; Alessandro C. Pasqualotto; G. Marshall Lyon; Michelle Barron; Shahid Husain; Marilyn M. Wagener; Jose G. Montoya. Risk factors and outcomes in lung transplant recipients with nodular invasive pulmonary aspergillosis. Journal of Infection 2013, 67, 72 -78.
AMA StyleNina Singh, Jose F. Suarez, Robin Avery, Cornelia Lass-Flörl, Christian Geltner, Alessandro C. Pasqualotto, G. Marshall Lyon, Michelle Barron, Shahid Husain, Marilyn M. Wagener, Jose G. Montoya. Risk factors and outcomes in lung transplant recipients with nodular invasive pulmonary aspergillosis. Journal of Infection. 2013; 67 (1):72-78.
Chicago/Turabian StyleNina Singh; Jose F. Suarez; Robin Avery; Cornelia Lass-Flörl; Christian Geltner; Alessandro C. Pasqualotto; G. Marshall Lyon; Michelle Barron; Shahid Husain; Marilyn M. Wagener; Jose G. Montoya. 2013. "Risk factors and outcomes in lung transplant recipients with nodular invasive pulmonary aspergillosis." Journal of Infection 67, no. 1: 72-78.
N. M. Singh; Shahid Husain; the AST Infectious Diseases Community of Practice. Aspergillosis in Solid Organ Transplantation. American Journal of Transplantation 2013, 13, 228 -241.
AMA StyleN. M. Singh, Shahid Husain, the AST Infectious Diseases Community of Practice. Aspergillosis in Solid Organ Transplantation. American Journal of Transplantation. 2013; 13 (s4):228-241.
Chicago/Turabian StyleN. M. Singh; Shahid Husain; the AST Infectious Diseases Community of Practice. 2013. "Aspergillosis in Solid Organ Transplantation." American Journal of Transplantation 13, no. s4: 228-241.
Donor‐derived fungal infections can be associated with serious complications in transplant recipients. Most cases of donor‐derived candidiasis have occurred in kidney transplant recipients in whom contaminated preservation fluid is a commonly proposed source. Donors with cryptococcal disease, including those with unrecognized cryptococcal meningoencephalitis may transmit the infection with the allograft. Active histoplasmosis or undiagnosed and presumably asymptomatic infection in the donor that had not resolved by the time of death can result in donor‐derived histoplasmosis in the recipient. Potential donors from an endemic area with either active or occult infection can also transmit coccidioidomycosis. Rare instances of aspergillosis and other mycoses, including agents of mucormycosis may also be transmitted from infected donors. Appropriate diagnostic evaluation and prompt initiation of appropriate antifungal therapy are warranted if donor‐derived fungal infections are a consideration. This document discusses the characteristics, evaluation and approach to the management of donor‐derived fungal infections in organ transplant recipients.
N. Singh; S. Huprikar; S. D. Burdette; M. I. Morris; J. E. Blair; L. J. Wheat. Donor-Derived Fungal Infections in Organ Transplant Recipients: Guidelines of the American Society of Transplantation, Infectious Diseases Community of Practice†. American Journal of Transplantation 2012, 12, 2414 -2428.
AMA StyleN. Singh, S. Huprikar, S. D. Burdette, M. I. Morris, J. E. Blair, L. J. Wheat. Donor-Derived Fungal Infections in Organ Transplant Recipients: Guidelines of the American Society of Transplantation, Infectious Diseases Community of Practice†. American Journal of Transplantation. 2012; 12 (9):2414-2428.
Chicago/Turabian StyleN. Singh; S. Huprikar; S. D. Burdette; M. I. Morris; J. E. Blair; L. J. Wheat. 2012. "Donor-Derived Fungal Infections in Organ Transplant Recipients: Guidelines of the American Society of Transplantation, Infectious Diseases Community of Practice†." American Journal of Transplantation 12, no. 9: 2414-2428.
Nina Singh. Unraveling the Biologic Basis of Late-Onset Cytomegalovirus Disease in High-Risk Organ Transplant Recipients. Transplantation 2011, 91, 825 -826.
AMA StyleNina Singh. Unraveling the Biologic Basis of Late-Onset Cytomegalovirus Disease in High-Risk Organ Transplant Recipients. Transplantation. 2011; 91 (8):825-826.
Chicago/Turabian StyleNina Singh. 2011. "Unraveling the Biologic Basis of Late-Onset Cytomegalovirus Disease in High-Risk Organ Transplant Recipients." Transplantation 91, no. 8: 825-826.
Real-time PCR has emerged as the preferred diagnostic assay for CMV. However, its utility as a preemptive therapy tool for CMV disease and related outcomes in liver transplant recipients has not been fully defined. Patients comprised 117 consecutive liver transplant recipients who underwent CMV surveillance monitoring using real-time PCR. Preemptive therapy with valganciclovir was employed upon detection of viremia. Baseline viral load was considered high based on log values (median). CMV viremia developed in 54% (63/117) of the patients, including 77% of R−/D+, 63% of R+/D+, 43% of R+/D−, and 10% of R−/D− patients. Overall, 23% (15/63) of the patients had recurrent viremia; R− serostatus (p = 0.065) but not initial viral load correlated with recurrent viremia (p = 0.80). At 12 months post-transplant, CMV disease occurred in 0.85% (1/117) of the patients (R+/D + recipient). None (0/30) of the R−/D + patients had CMV disease. Patients with CMV viremia treated preemptively did not differ significantly from those who never developed CMV viremia with regards to bacterial or fungal infections, rejection, graft loss, mortality rate, and probability of survival at 12 months (p > 0.05 for all variables). The above outcomes also did not differ for patients with high (> 1.9 logs) vs. low viral load (< 1.9 logs) (p > 0.05 for all outcomes). Preemptive therapy guided by real-time PCR based monitoring led to outcomes in all patients or in those with high viral loads that were comparable to outcomes in patients who never developed viremia or had low viral loads, respectively. Late-onset CMV disease at 12 months was observed in < 1% of all patients.
Hsin-Yun Sun; Thomas V. Cacciarelli; Marilyn M. Wagener; Nina Singh. Preemptive therapy for cytomegalovirus based on real-time measurement of viral load in liver transplant recipients. Transplant Immunology 2010, 23, 166 -169.
AMA StyleHsin-Yun Sun, Thomas V. Cacciarelli, Marilyn M. Wagener, Nina Singh. Preemptive therapy for cytomegalovirus based on real-time measurement of viral load in liver transplant recipients. Transplant Immunology. 2010; 23 (4):166-169.
Chicago/Turabian StyleHsin-Yun Sun; Thomas V. Cacciarelli; Marilyn M. Wagener; Nina Singh. 2010. "Preemptive therapy for cytomegalovirus based on real-time measurement of viral load in liver transplant recipients." Transplant Immunology 23, no. 4: 166-169.
Nina Singh. Prevention of Cytomegalovirus in Organ Transplant Recipients: Cross Roads Between Antiviral and Antitumor Immunity. Transplantation 2010, 90, 360 -361.
AMA StyleNina Singh. Prevention of Cytomegalovirus in Organ Transplant Recipients: Cross Roads Between Antiviral and Antitumor Immunity. Transplantation. 2010; 90 (4):360-361.
Chicago/Turabian StyleNina Singh. 2010. "Prevention of Cytomegalovirus in Organ Transplant Recipients: Cross Roads Between Antiviral and Antitumor Immunity." Transplantation 90, no. 4: 360-361.
BackgroundClinical characteristics, risks, and outcomes in solid organ transplant (SOT) recipients with zygomycosis in the era of modern immunosuppressive and newer antifungal agent use have not been defined MethodsIn a matched case-controlled study, SOT recipients with zygomycosis were prospectively studied. The primary outcome measure was success (complete or partial response) at 90 days ResultsRenal failure (odds ratio [OR], 3.17; P=.010), diabetes mellitus (OR, 8.11; P<.001), and prior voriconazole and/or caspofungin use (OR, 4.41; P=.033) were associated with a higher risk of zygomycosis, whereas tacrolimus (OR, 0.23; P=.002) was associated with a lower risk of zygomycosis. Liver transplant recipients were more likely to have disseminated disease (OR, 5.48; P=.021) and developed zygomycosis earlier after transplantation than did other SOT recipients (median, 0.8 vs 5.7 months; P<.001). Overall the treatment success rate was 60%. Renal failure (OR, 11.3; P=.023) and disseminated disease (OR, 14.6; P=.027) were independently predictive of treatment failure, whereas surgical resection was associated with treatment success (OR, 33.3; P=.003). The success rate with liposomal amphotericin B was 4-fold higher even when controlling for the aforementioned variables ConclusionsThe risks identified for zygomycosis and for disseminated disease, including those that were previously unrecognized, have implications for further elucidating the biologic basis and for optimizing outcomes in SOT recipients with zygomycosis
Nina Singh; Jose M. Aguado; Hugo Bonatti; Graeme Forrest; Krishan L. Gupta; Nasia Safdar; George T. John; Kenneth J. Pursell; Patricia Muñoz; Robin Patel; Jesus Fortun; Pilar Martín-Dávila; Bruno Philippe; François Philit; Alexis Tabah; Nicolas Terzi; Valérie Chatelet; Shimon Kusne; Nina Clark; Emily Blumberg; Marino Blanes Julia; Abhi Humar; Sally Houston; Cornelia Lass‐Flörl; Leonard Johnson; Erik R. Dubberke; Michelle A. Barron; Olivier Lortholary. Zygomycosis in Solid Organ Transplant Recipients: A Prospective, Matched Case‐Control Study to Assess Risks for Disease and Outcome. Journal of Infectious Diseases 2009, 200, 1002 -1011.
AMA StyleNina Singh, Jose M. Aguado, Hugo Bonatti, Graeme Forrest, Krishan L. Gupta, Nasia Safdar, George T. John, Kenneth J. Pursell, Patricia Muñoz, Robin Patel, Jesus Fortun, Pilar Martín-Dávila, Bruno Philippe, François Philit, Alexis Tabah, Nicolas Terzi, Valérie Chatelet, Shimon Kusne, Nina Clark, Emily Blumberg, Marino Blanes Julia, Abhi Humar, Sally Houston, Cornelia Lass‐Flörl, Leonard Johnson, Erik R. Dubberke, Michelle A. Barron, Olivier Lortholary. Zygomycosis in Solid Organ Transplant Recipients: A Prospective, Matched Case‐Control Study to Assess Risks for Disease and Outcome. Journal of Infectious Diseases. 2009; 200 (6):1002-1011.
Chicago/Turabian StyleNina Singh; Jose M. Aguado; Hugo Bonatti; Graeme Forrest; Krishan L. Gupta; Nasia Safdar; George T. John; Kenneth J. Pursell; Patricia Muñoz; Robin Patel; Jesus Fortun; Pilar Martín-Dávila; Bruno Philippe; François Philit; Alexis Tabah; Nicolas Terzi; Valérie Chatelet; Shimon Kusne; Nina Clark; Emily Blumberg; Marino Blanes Julia; Abhi Humar; Sally Houston; Cornelia Lass‐Flörl; Leonard Johnson; Erik R. Dubberke; Michelle A. Barron; Olivier Lortholary. 2009. "Zygomycosis in Solid Organ Transplant Recipients: A Prospective, Matched Case‐Control Study to Assess Risks for Disease and Outcome." Journal of Infectious Diseases 200, no. 6: 1002-1011.
The precise role of cytomegalovirus (CMV) infection in contributing to outcomes in critically ill immunocompetent patients has not been fully defined.
Ryosuke Osawa; Nina Singh. Cytomegalovirus infection in critically ill patients: a systematic review. Critical Care 2009, 13, R68 -R68.
AMA StyleRyosuke Osawa, Nina Singh. Cytomegalovirus infection in critically ill patients: a systematic review. Critical Care. 2009; 13 (3):R68-R68.
Chicago/Turabian StyleRyosuke Osawa; Nina Singh. 2009. "Cytomegalovirus infection in critically ill patients: a systematic review." Critical Care 13, no. 3: R68-R68.
Cryptococcosis remains a significant opportunistic infection in solid organ transplant recipients. Disease presentation and outcomes in the current era may be affected amongst other factors by the use of calcineurin-inhibitor immunosuppressive agents. It is being increasingly recognized that rapid reversal of immunosuppression in transplant recipients treated for cryptococcosis incurs the risk of immune reconstitution inflammatory syndrome that mimics worsening disease or relapse. This review summarizes the current state of knowledge regarding cryptococcosis in transplant recipients and highlights areas where future investigations are needed to further optimize outcomes in these patients.
Nina Singh; Francoise Dromer; John R. Perfect; Olivier Lortholary. Immunocompromised Hosts: Cryptococcosis in Solid Organ Transplant Recipients: Current State of the Science. Clinical Infectious Diseases 2008, 47, 1321 -1327.
AMA StyleNina Singh, Francoise Dromer, John R. Perfect, Olivier Lortholary. Immunocompromised Hosts: Cryptococcosis in Solid Organ Transplant Recipients: Current State of the Science. Clinical Infectious Diseases. 2008; 47 (10):1321-1327.
Chicago/Turabian StyleNina Singh; Francoise Dromer; John R. Perfect; Olivier Lortholary. 2008. "Immunocompromised Hosts: Cryptococcosis in Solid Organ Transplant Recipients: Current State of the Science." Clinical Infectious Diseases 47, no. 10: 1321-1327.
Background. Prognostic implications of cryptococcal antigen and outcomes associated with central nervous system (CNS) cryptococcal lesions in solid organ transplant recipients have not been fully defined. Methods. Patients were derived form a cohort of 122 solid organ transplant recipients with cryptococcosis in a multicenter study from 1999 to 2006. Results. Central nervous system cryptococcosis was documented in 61 patients. Serum or cerebral spinal fluid antigen titers did not correlate with mortality at 90 days or cerebral spinal fluid sterilization at 2 weeks. Central nervous system lesions were identified in 16 patients and included leptomeningeal lesions in eight, parenchymal lesions in six, and hydrocephalus in two. Overall, 13/16 CNS lesions were present at the time of diagnosis. One parenchymal and two hydrocephalus lesions, however, developed after diagnosis and fulfilled the criteria for immune reconstitution syndrome. Cerebral spinal fluid antigen titers were higher with meningeal versus parenchymal lesions, and hydrocephalus (P=0.015). Mortality was 50% (3/6) for patients with parenchymal, 12.5% (1/8) for those with leptomeningeal, and 0/3 for patients with hydrocephalus. Mortality was 31% (4/13) for patients with CNS lesions at baseline and 0/3 in those with new onset lesions. Conclusions. Despite a higher antigen titer with meningeal lesions, outcomes tended to be worse with parenchymal compared with meningeal lesions or hydrocephalus. New onset CNS lesions may represent immune reconstitution syndrome and seemed to be associated with better outcome.
Nina Singh; Olivier Lortholary; Françoise Dromer; Barbara D. Alexander; Krishan L. Gupta; George T. John; Ramon Del Busto; Goran B. Klintmalm; Jyoti Somani; G. Marshall Lyon; Kenneth Pursell; Valentina Stosor; Patricia Muňoz; Ajit P. Limaye; Andre C. Kalil; Timothy L. Pruett; Patricia Carmen Muñoz García; Atul Humar; Sally Houston; Andrew A. House; Dannah Wray; Susan Orloff; Lorraine A. Dowdy; Robert A. Fisher; Joseph Heitman; Marilyn M. Wagener; Shahid Husain. Central Nervous System Cryptococcosis in Solid Organ Transplant Recipients: Clinical Relevance of Abnormal Neuroimaging Findings. Transplantation 2008, 86, 647 -651.
AMA StyleNina Singh, Olivier Lortholary, Françoise Dromer, Barbara D. Alexander, Krishan L. Gupta, George T. John, Ramon Del Busto, Goran B. Klintmalm, Jyoti Somani, G. Marshall Lyon, Kenneth Pursell, Valentina Stosor, Patricia Muňoz, Ajit P. Limaye, Andre C. Kalil, Timothy L. Pruett, Patricia Carmen Muñoz García, Atul Humar, Sally Houston, Andrew A. House, Dannah Wray, Susan Orloff, Lorraine A. Dowdy, Robert A. Fisher, Joseph Heitman, Marilyn M. Wagener, Shahid Husain. Central Nervous System Cryptococcosis in Solid Organ Transplant Recipients: Clinical Relevance of Abnormal Neuroimaging Findings. Transplantation. 2008; 86 (5):647-651.
Chicago/Turabian StyleNina Singh; Olivier Lortholary; Françoise Dromer; Barbara D. Alexander; Krishan L. Gupta; George T. John; Ramon Del Busto; Goran B. Klintmalm; Jyoti Somani; G. Marshall Lyon; Kenneth Pursell; Valentina Stosor; Patricia Muňoz; Ajit P. Limaye; Andre C. Kalil; Timothy L. Pruett; Patricia Carmen Muñoz García; Atul Humar; Sally Houston; Andrew A. House; Dannah Wray; Susan Orloff; Lorraine A. Dowdy; Robert A. Fisher; Joseph Heitman; Marilyn M. Wagener; Shahid Husain. 2008. "Central Nervous System Cryptococcosis in Solid Organ Transplant Recipients: Clinical Relevance of Abnormal Neuroimaging Findings." Transplantation 86, no. 5: 647-651.
The propensity of liver transplant recipients to develop more fulminant disease presentation and a higher risk of disseminated disease due to a number of opportunistic infections, including invasive aspergillosis, cryptococcosis, zygomycosis, may be related to iron overload. Abnormalities in iron homeostasis may also be a contributor to severe manifestations due to other pathogens such as cytomegalovirus and Staphylococcus aureus in liver transplant recipients. Iron is essential not only for microbial pathogenesis, but directly impairs pivotal pathogen specific host defenses. Studies to assess iron homeostasis and the mechanisms by which iron overload contributes to the pathogenesis of opportunistic infections in liver transplant recipients are warranted.
Nina Singh; Hsin-Yun Sun. Iron overload and unique susceptibility of liver transplant recipients to disseminated disease due to opportunistic pathogens. Liver Transplantation 2008, 14, 1249 -1255.
AMA StyleNina Singh, Hsin-Yun Sun. Iron overload and unique susceptibility of liver transplant recipients to disseminated disease due to opportunistic pathogens. Liver Transplantation. 2008; 14 (9):1249-1255.
Chicago/Turabian StyleNina Singh; Hsin-Yun Sun. 2008. "Iron overload and unique susceptibility of liver transplant recipients to disseminated disease due to opportunistic pathogens." Liver Transplantation 14, no. 9: 1249-1255.
Nina Singh. Optimal Prevention of Late‐Onset Cytomegalovirus (CMV) Disease and Other Sequelae of CMV Infection in Organ Transplant Recipients. Clinical Infectious Diseases 2008, 47, 296 -297.
AMA StyleNina Singh. Optimal Prevention of Late‐Onset Cytomegalovirus (CMV) Disease and Other Sequelae of CMV Infection in Organ Transplant Recipients. Clinical Infectious Diseases. 2008; 47 (2):296-297.
Chicago/Turabian StyleNina Singh. 2008. "Optimal Prevention of Late‐Onset Cytomegalovirus (CMV) Disease and Other Sequelae of CMV Infection in Organ Transplant Recipients." Clinical Infectious Diseases 47, no. 2: 296-297.
Immune regulatory pathways involving the newly discovered T regulatory (Treg) and Th17 cells are amongst the principal targets of immunosuppressive agents employed in transplant recipients and key mediators of host inflammatory responses in fungal infections. These novel signaling pathways, in concert with or independent of Th1/Th2 responses, have potentially important implications for yielding valuable insights into the pathogenesis of immune reconstitution syndrome (IRS) in transplant recipients, for aiding the diagnosis of this entity, and for achieving a balance of immune responses that enhance host immunity while curbing unfettered inflammation in IRS.
Nina Singh. Novel immune regulatory pathways and their role in immune reconstitution syndrome in organ transplant recipients with invasive mycoses. European Journal of Clinical Microbiology & Infectious Diseases 2008, 27, 403 -408.
AMA StyleNina Singh. Novel immune regulatory pathways and their role in immune reconstitution syndrome in organ transplant recipients with invasive mycoses. European Journal of Clinical Microbiology & Infectious Diseases. 2008; 27 (6):403-408.
Chicago/Turabian StyleNina Singh. 2008. "Novel immune regulatory pathways and their role in immune reconstitution syndrome in organ transplant recipients with invasive mycoses." European Journal of Clinical Microbiology & Infectious Diseases 27, no. 6: 403-408.
Role of serum cryptococcal antigen in the diagnosis and determinants of antigen positivity in solid organ transplant (SOT) recipients with pulmonary cryptococcosis has not been fully defined. Study population included SOT recipients with pulmonary cryptococcosis in a prospective, multicenter study conducted between 1999 and 2006. Cryptococcal antigen was positive in 83% (40/48) of the patients with pulmonary cryptococcosis. Patients with concomitant extrapulmonary disease were more likely to have a positive antigen (p=0.018), and antigen titers were higher in those with extrapulmonary disease (p=0.003) or fungemia (p=0.045). Patients with single nodules were less likely to have a positive antigen than those with all other radiographic presentations (p=0.053). Among patients with isolated pulmonary cryptococcosis, lung transplant recipients were less likely to have positive cryptococcal antigen than other types of SOT recipients (p=0.003). In all, 38% of the patients were asymptomatic or had pulmonary cryptococcosis detected as an incidental finding. Nodular densities or mass lesions were more likely to present as asymptomatic or incidentally detected pulmonary cryptococcosis than pleural effusions and infiltrates (p=0.008). A positive serum cryptococcal antigen in SOT recipients with pulmonary cryptococcosis appears to reflect extrapulmonary or more advanced radiographic disease.
Nina Singh; Barbara D. Alexander; Olivier Lortholary; Françoise Dromer; Krishan L. Gupta; George T. John; Ramon Del Busto; Goran B. Klintmalm; Jyoti Somani; G. Marshall Lyon; Kenneth Pursell; Valentina Stosor; Patricia Muňoz; Ajit P. Limaye; Andre C. Kalil; Timothy L. Pruett; Patricia Carmen Muñoz García; Atul Humar; Sally Houston; Andrew A. House; Dannah Wray; Susan Orloff; Lorraine A. Dowdy; Robert A. Fisher; Joseph Heitman; Marilyn M. Wagener; Shahid Husain. Pulmonary Cryptococcosis in Solid Organ Transplant Recipients: Clinical Relevance of Serum Cryptococcal Antigen. Clinical Infectious Diseases 2008, 46, e12 -e18.
AMA StyleNina Singh, Barbara D. Alexander, Olivier Lortholary, Françoise Dromer, Krishan L. Gupta, George T. John, Ramon Del Busto, Goran B. Klintmalm, Jyoti Somani, G. Marshall Lyon, Kenneth Pursell, Valentina Stosor, Patricia Muňoz, Ajit P. Limaye, Andre C. Kalil, Timothy L. Pruett, Patricia Carmen Muñoz García, Atul Humar, Sally Houston, Andrew A. House, Dannah Wray, Susan Orloff, Lorraine A. Dowdy, Robert A. Fisher, Joseph Heitman, Marilyn M. Wagener, Shahid Husain. Pulmonary Cryptococcosis in Solid Organ Transplant Recipients: Clinical Relevance of Serum Cryptococcal Antigen. Clinical Infectious Diseases. 2008; 46 (2):e12-e18.
Chicago/Turabian StyleNina Singh; Barbara D. Alexander; Olivier Lortholary; Françoise Dromer; Krishan L. Gupta; George T. John; Ramon Del Busto; Goran B. Klintmalm; Jyoti Somani; G. Marshall Lyon; Kenneth Pursell; Valentina Stosor; Patricia Muňoz; Ajit P. Limaye; Andre C. Kalil; Timothy L. Pruett; Patricia Carmen Muñoz García; Atul Humar; Sally Houston; Andrew A. House; Dannah Wray; Susan Orloff; Lorraine A. Dowdy; Robert A. Fisher; Joseph Heitman; Marilyn M. Wagener; Shahid Husain. 2008. "Pulmonary Cryptococcosis in Solid Organ Transplant Recipients: Clinical Relevance of Serum Cryptococcal Antigen." Clinical Infectious Diseases 46, no. 2: e12-e18.