Cryptococcal antigenemia prevalence and clinical data in HIV‐infected patients from the reference centre at INI‐FIOCRUZ, Rio de Janeiro, Southeast of Brazil

Ferreira, Marcelle de Lima; Brito‐Santos, Fabio; Trilles, Luciana; Almeida, Marcos de Abreu; Wanke, Bodo; Veloso, Valdiléa G.; Nunes, Estêvão Portela; Lazéra, Márcia dos Santos

doi:10.1111/myc.13032

Cited by 7 publications

(18 citation statements)

References 22 publications

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“…For more information about the reporting criteria in each country, see Supplementary Data (Supplementary Material) . Considering all regional publications, four reported the frequency of CrAg in patients with ≤100 cells/mm 3 [ 9 , 10 , 11 , 12 ] and three in patients with <200 cells/mm 3 [ 9 , 13 , 14 ]. Using these results and ours, the estimated overall CrAg frequency in the region for PLWHIV with <100 CD4 cells/mm 3 was 9.2% (IC95% 7.9–10.7%) and 8.1% in those with AHD (IC95% 7.9–10.7%).…”

Section: Resultsmentioning

confidence: 99%

“…Among Latin American people with HIV, we estimated that CrAg positivity is 9.2% (IC95% 7.9–10.7%) in patients with <100 CD4/mm 3 [ 9 , 10 , 11 , 12 , 13 , 14 ]. This number is 3.2% higher than the global estimation by Rajasingham et al in asymptomatic patients [ 2 ], which is an uncertain denomination considering the deep immunosuppressed status of such HIV patients.…”

Section: Discussionmentioning

confidence: 99%

“…This number is 3.2% higher than the global estimation by Rajasingham et al in asymptomatic patients [ 2 ], which is an uncertain denomination considering the deep immunosuppressed status of such HIV patients. In published articles from Brazil, Argentina and Honduras, the criteria to establish the burden of cryptococcal disease were similar, with CD4 thresholds of <100 or <200 cells/mm 3 [ 10 , 11 , 13 ]. However, in Guatemala, we screened patients regardless of the CD4 cell count, symptoms, or hospitalized status, with an overall incidence of 4.8% ( Table 2 ), which is a real measurement of the burden of disease in PLWHIV.…”

Section: Discussionmentioning

confidence: 99%

“…Evaluating the absence or the presence of symptoms in highly immunosuppressed populations is a risky exercise. For instance, only asymptomatic hospitalized patients were included in the study by Vidal et al [ 13 ], where only a 3.1% incidence was ascertained, and this may mean that patients had another diseases that caused hospitalization and cryptococcal cases diagnosed were comorbidities more than a burden of this disease in asymptomatic people at risk. Thus, to establish the burden of disease, we can choose an objective entry criterion, such as CD4 threshold.…”

Section: Discussionmentioning

confidence: 99%

“… Frequencies of cryptococcal antigenemia in LATAM among patients with ≤100 cells/mm 3 and those with AHD (<200 CD4/mm 3 ) [ 9 , 10 , 11 , 12 , 13 , 14 ]. …”

Section: Figurementioning

confidence: 99%

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Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program

Medina¹,

Rodríguez-Tudela²,

Pérez

et al. 2022

Microorganisms

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Cryptococcal disease is an important opportunistic infection among people living with HIV. The cryptococcal antigen (CrAg) can be detected before the clinical onset of meningitis and its screening is recommended. Here, we evaluated CrAg frequency, and describe the epidemiological characteristics and mortality at 180 days in a cohort of HIV patients from Guatemala. A total of 3457 patients were screened with a CrAg lateral flow assay in serum between January 2017 and December 2018. CrAg positivity was 11.5% in patients with ≤100 CD4/mm3, 8.7% in patients with <200 CD4/mm3, and 6.3% in patients with <350 CD4/mm3. In Latin America, we estimated 9.2% CrAg positivity (IC95% 7.9–10.7%) in patients with ≤100 CD4/mm3. Among patients newly diagnosed with HIV, we estimated 4416 incident cases per year in Latin America in those with <200 CD4/mm3 and 5289 in those with <350 CD4/mm3. In addition, we calculated the burden in people not on ARV or without viral suppression and found 28,672 cases. CrAg screening should be considered in patients who have a CD4 cell count < 350 cells/mm3. Cryptococcal meningitis was associated with 30.8% mortality in Guatemala. Global access to diagnosis as well as to liposomal amphotericin B and flucytosine is a priority.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“… Frequencies of cryptococcal antigenemia in LATAM among patients with ≤100 cells/mm 3 and those with AHD (<200 CD4/mm 3 ) [ 9 , 10 , 11 , 12 , 13 , 14 ]. …”

Section: Figurementioning

confidence: 99%

See 3 more Smart Citations

Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program

Medina¹,

Rodríguez-Tudela²,

Pérez

et al. 2022

Microorganisms

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High prevalence of central nervous system cryptococcosis using a fingerprick whole-blood lateral flow assay in individuals with neurological symptoms and advanced HIV disease in a Brazilian emergency department

Oliveira,

Nakagawa,

de Oliveira

et al. 2023

Medical Mycology

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Timely diagnosis is key in managing central nervous system (CNS) cryptococcosis in people living with HIV/AIDS (PLWHA). There are few data on implementing fingerprick whole-blood cryptococcal antigen (CrAg) lateral flow assay (LFA) as the first test for diagnosing CNS cryptococcosis. We evaluated the prevalence of CNS cryptococcosis and cryptococcal antigenemia using fingerprick whole-blood in a referral emergency department (ED) in São Paulo, Brazil. This was a prospective cohort study of consecutive adult PLWHA with advanced HIV disease and neurological symptoms. Fingerprick whole-blood CrAg LFA was performed at bedside. Seventy-four individuals were enrolled (median age = 40 years; males = 62%). Prevalence of CNS cryptococcosis was 17.6% (13/74); 95% CI, 9.4 to 30.0% and prevalence of positive fingerprick whole-blood CrAg LFA was 25.7% (19/74); 95% CI, 15.5 to 40.1%. Among the six (8.1%) patients with positive fingerprick whole-blood CrAg LFA and negative CSF CrAg LFA, four (5.4%) had isolated asymptomatic cryptococcal antigenemia, one (1.3%) had symptomatic cryptococcal antigenemia, and one (1.3%) had cryptococcemia. Prevalence of CNS cryptococcosis and cryptococcal antigenemia using fingerprick whole-blood CrAg LFA were high. Point-of-care testing was important for diagnosing CNS cryptococcosis in an ED from a middle-income country.

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Prevalence of Cryptococcal Antigen and Outcomes in People With Human Immunodeficiency Virus in Honduras: A Cohort Study

Zuniga-Moya

Romero-Reyes

Saavedra

et al. 2020

Open Forum Infectious Diseases

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Background Cryptococcal meningitis is a major cause of death among people living with HIV (PLWH). Cryptococcal antigen (CrAg) testing of asymptomatic patients is an important public health measure to reduce mortality in high incidence areas. However, limited data exists on CrAg prevalence in Central America. Methods We conducted a prospective cohort study at the two largest HIV clinics and hospitals in Honduras. CrAg in serum and cerebrospinal fluid was performed in individuals living with HIV who had CD4 ≤ 100 cells/mm 3 between 2017-2018. After CrAg testing, individuals were followed up for 12 months to assess mortality using adjusted cox proportional hazard models. Results A total of 220 PLWH were tested for CrAg of which 12.7% (n=28) tested positive. CrAg prevalence was higher among hospitalized individuals in 40% (n=10 of 25) of the cases. The proportion (35.8%) of individuals taking ART was significantly (p<0.01) lower among those who tested positive for CrAg. Overall mortality among the cohort was 11.4% (n=25 of 220) by 12 months. CrAg-positive cases were at a significantly higher risk of death [aHR: 2.69, 95%: 1.07-6.84] when compared to CrAg-negative participants. Conclusions CrAg prevalence in Honduras was high among PLWH. Moreover, individuals who tested positive for CrAg testing were at a higher risk of death. Systemic CrAg of PLWH with a CD4 ≤ 100 cells/mm 3 should be routinely performed in Central America.

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Cryptococcal antigenemia prevalence and clinical data in HIV‐infected patients from the reference centre at INI‐FIOCRUZ, Rio de Janeiro, Southeast of Brazil

Cited by 7 publications

References 22 publications

Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program

Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program

High prevalence of central nervous system cryptococcosis using a fingerprick whole-blood lateral flow assay in individuals with neurological symptoms and advanced HIV disease in a Brazilian emergency department

Prevalence of Cryptococcal Antigen and Outcomes in People With Human Immunodeficiency Virus in Honduras: A Cohort Study

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