Prevalence, Correlates, and Outcomes of Cryptococcal Antigen Positivity Among Patients With AIDS, United States, 1986–2012

McKenney, Jennie; Bauman, Sean K.; Neary, Brandon; Detels, Roger; French, Audrey L.; Margolick, Joseph B.; Doherty, Brian J.; Klausner, Jeffrey D.

doi:10.1093/cid/ciu937

Cited by 72 publications

(62 citation statements)

References 33 publications

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“…The overall prevalence of positive serum CrAg in the present study is similar to that reported by other authors in Uganda, with a prevalence rate of 8.8%, among patients with a CD4+ cell count <100 cells/mL [12]. These prevalence rates are lower than to those from Cambodia and South Africa among patients with similar demographic characteristics [17,18] and are three times greater than those reported from the United States, using the same assessment methods [19]. …”

Section: Discussionsupporting

confidence: 88%

Prevalence of cryptococcal infection among advanced HIV patients in Argentina using lateral flow immunoassay

et al. 2017

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BackgroundGlobally, Latin America ranks third among regions with most cases of AIDS related cryptococcal meningitis. In 2009, a lateral flow immunoassay (LFA) for the detection of cryptococcal antigen (CrAg) was developed as a potential point-of-care test for diagnosis of cryptococcal infection. In 2011 World Health Organizations recommended on CrAg screening for HIV positive persons with CD4 below 100 cells/μL, followed by preemptive fluconazole treatment. However, in Argentina no formal recommendations for CrAg screening have been issued.MethodsHIV positive patients > = 18 years with advanced immunosuppression (CD4 counts ≤100 cells/μL within 3 months or WHO stage III/IV), who visited the hospital between April 1, 2014 and January 31, 2015, were included. The LFA was performed according to the manufacturer’s instructions on all serum samples. When CrAg detection was positive, a lumbar puncture was performed to rule out cryptococcal meningitis. Patients without evidence of meningeal involvement were treated with preemptive oral fluconazole in ambulatory care.ResultsWe included 123 patients. Prevalence of CrAg-positivity was 8.1%. Among the 10 CrAg-positive patients, 6 had meningeal involvement detected through the CSF analysis (CSF India-ink testing, CSF CrAg and culture). The remaining 4 patients with positive CrAg received targeted preemptive treatment with oral fluconazole and were free of cryptococcal disease during the follow-up period. None of the 113 patients with a negative CrAg test result developed cryptococcal disease.ConclusionsThis is the first study in Argentina, to our knowledge, describing the prevalence of cryptococcosis and usefulness of CrAg screening. LFA provided early diagnosis to determine a high prevalence of CrAg in our hospital, and that screening for subclinical infection with preemptive antifungal treatment, prevented a substantial proportion of meningeal disease.

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Section: Discussionsupporting

confidence: 88%

Prevalence of cryptococcal infection among advanced HIV patients in Argentina using lateral flow immunoassay

et al. 2017

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“…In Ecuador according to MSP 3,546 new AIDS cases were recorded in 2014. Another analysis found the prevalence of cryptococcal antigenemia is 2.9%, among HIV patients [10].…”

Section: Methodsmentioning

confidence: 98%

Serious fungal infections in Ecuador

Zurita

Denning

Paz-y-Miño³

et al. 2017

Eur J Clin Microbiol Infect Dis

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“…Some data suggest a ‘screen and treat’ would be cost effective, even in resource-rich settings, although this is currently not part of standard practice, despite recent reports of CrAg prevalence of more than 3% in the United States. 176,182 Routine screening for cryptococcal infection and/or prophylaxis are not recommended in solid organ transplant recipients, even when immunosuppression is augmented in patients with previously (appropriately) treated infection. 183 …”

Section: Treatmentmentioning

confidence: 99%