Cryptococcosis is the third most common cause of invasive fungal infection in solid organ transplant recipients and cryptococcal meningitis (CM) its main clinical presentation. CM outcomes, as well as its clinical features and radiological characteristics, have not yet been considered on a large scale in the context of kidney transplantation (KT). We performed a nationwide retrospective study of adult patients diagnosed with cryptococcosis after KT between 2002 and 2020 across 30 clinical centers in France. We sought to describe overall and graft survival based on whether KT patients with cryptococcosis developed CM or not. Clinical indicators of CNS involvement and brain radiological characteristics were assessed. Eighty-eight cases of cryptococcosis were diagnosed during the study period, with 61 (69.3%) cases of CM. Mortality was high (32.8%) at 12 months (M12) but not significantly different whether or not patients presented with CM. Baseline hyponatremia and at least one neurological symptom were independently associated with CM (p < 0.001). Positive serum cryptococcal antigen at diagnosis was also significantly associated with CM (p < 0.001). On magnetic resonance imaging (MRI), three patterns of brain injury were identified: parenchymal, meningeal, and vascular lesions. Although CM does not affect graft function directly, it entails a grim prognosis.

Phaeohyphomycoses (PHM), infections caused by pigmented fungi, are increasingly reported in kidney transplant recipients (KTR), but data remains scarce. We retrospectively reviewed all episodes of PHM in KTR at the Guadeloupe University Hospital (French West Indies) from January 1st, 2012, to December 31st, 2022. Eighteen episodes of PHM occurred in 17 KTRs, corresponding to an incidence of 1.56 cases per 100 person-years. Median time from transplantation to PHM onset was 15 months (interquartile range: 9.0–23.5 months). Most episodes were localized cutaneous infections (n = 16/18). Twelve fungal species were identified; Paraconiothyrium cyclothyrioides was the most frequent (n = 6/18, 33%). This fungus it is not yet acknowledged as pathogenic in the current European guidelines. Surgery was performed in 41% of episodes with available data—some data are missing due to the loss of paper files. Eighty-two percent of patients received antifungal therapy (mainly azoles). Overall outcome was favorable in 82%. Three deaths occurred during follow-up; one was directly attributable to disseminated PHM. Diagnosing PHM is not that unusual in this caribbean transplant center, mainly presented as localized skin infections, with a distinctive species distribution characterized by predominance of P. cyclothyrioides and absence of Alternaria spp. With accurate diagnosis, combine surgical/medical therapy and control of transplant organ management, the vast majority of patients can be successfully managed.

Few studies have focused on the infectious complications in kidney transplant recipients in tropical regions, particularly in the Caribbean. The primary objective of this study was to determine the incidence of bacterial, fungal, and parasitic infections in kidney transplant recipients in the French Caribbean and French Guiana. We included all patients who received a kidney transplant at the University Hospital of Guadeloupe between January 2014 and October 2016, with post-transplant follow-up in the French Caribbean. A total of 91 patients were included, of whom 57 developed an infectious event during follow-up. When infections were documented (94/111), bacterial infections were the most frequent (79/94), followed by fungal (11/94) and parasitic infections (4/94). Four cases of nocardiosis were identified (4/79). Phaeohyphomycosis was the most common fungal infection (7/11). In a multivariate analysis, the female gender and diabetes mellitus at the time of transplant were significantly associated with a higher risk of infection. This study is the first to describe the epidemiology of infections in kidney transplant recipients in the Caribbean and to analyze the potential risk factors. We reported a similar profile of bacterial infections to that which were observed in the European and American studies. However, we found a higher incidence of tropical infections, such as nocardiosis and phaeohyphomycosis, which highlights the need for heightened awareness among healthcare teams to ensure earlier and more appropriate treatment. Further studies focusing on these rare tropical infections are necessary to better understand their risk factors

Objectives: Infective endocarditis (IE) is rare but severe, and its epidemiology and outcome in solid organ transplant (SOT) and haematopoietic stem cell transplant (HSCT) recipients remain poorly described. This study aimed to characterise IE in SOT/HSCT recipients and to compare its features with those of non-transplant patients. Methods: A multicentre retrospective cohort study was conducted across 27 hospitals in France, including all SOT/HSCT recipients with definite or possible IE, according to the 2023 Duke–ISCVID criteria, between 2007 and 2023. SOT/HSCT recipients were compared with non-transplant controls from two French IE cohorts using 1:1 propensity score matching. Cox proportional hazards models were used to assess 90-day and 1-year all-cause mortality. Results: 262 SOT/HSCT recipients with IE and 1573 controls were included. Among transplant recipients, the most frequent pathogens were Staphylococcus aureus (25%, 66/262), Enterococcus spp. (21%, 55/262), and coagulase-negative staphylococci (CoNS) (16%, 42/262). Microbiological patterns varied according to time since transplantation, with more fungal and CoNS IE within the first year and more streptococcal IE thereafter (p=0.01). After matching, pathogen distribution differed, with fewer streptococcal IE and more Enterococcus spp., CoNS, non-HACEK Gram-negative bacilli, and fungal IE in SOT/HSCT recipients (p<0.001). In multivariable analysis, SOT/HSCT status was independently associated with higher 1-year all-cause mortality (adjusted HR 1.69, 95% CI 1.05–2.72; p=0.029), but not 90-day mortality. Conclusions: IE in transplant recipients has distinct clinical and microbiological features and is associated with increased 1-year mortality. Time since transplantation may help inform diagnostic evaluation and empirical antimicrobial strategies.