Diagnosis of central nervous system mycoses in solid organ transplant recipients.

TO THE EDITOR—We read with interest the informative review by Wright and Fishman about central nervous system (CNS) syndromes in recipients of solid organ transplant (SOT) [1]. However, we believe that at least 2 points of their article deserve comments. First, in their Table 4, the authors report the “approximate incidence and usual post-transplant onset” of aspergillosis, cryptococcosis, and endemic fungi adapted from the TransplantAssociated Infection Surveillance Network (TRANSNET) study [2]. In fact, in the TRANSNET cohort surveillance, the overall incidence of aspergillosis was reported to be 0.7% (instead of 0.2%) and for cryptococcosis 0.2% (instead of 0.1%). More importantly, these incidence rates refer to all the manifestations caused by the invasive mycoses and not solely to those with CNS involvement. Specifically for aspergillosis, 78% of cases were limited to the lungs, but the article does not mention whether the remaining patients had CNS involvement. As far as cryptococcosis is concerned, in the TRANSNET study only 45% of patients had CNS involvement [2], in agreement with previous studies showing that among SOT recipients, as opposed to human immunodeficiency virus–infected patients, CNS cryptococcosis is observed in 34%–52% of cases [3, 4]. Moreover, the TRANSNET study included 48 cases of histoplasmosis, 7 cases of coccidioidomycosis, and 9 cases