Asymptomatic cryptococcal antigen prevalence detected by lateral flow assay in hospitalised HIV‐infected patients in São Paulo, Brazil

Vidal, José Ernesto; Toniolo, Carolina; Paulino, Adriana; Colombo, Arnaldo Lopes; Martins, Marilena dos Anjos; Meira, Cristina da Silva; Pereira-Chioccola, Vera Lúcia; Figueiredo-Mello, Claudia; Barros, Tiago Dahrug; Duarte, Jequelie; Fonseca, Fernanda Fernandes; Cunha, Mirella Alves; Mendes, Clara; Ribero, Taiana; Lazéra, Márcia dos Santos; Rajasingham, Radha; Boulware, David R.

doi:10.1111/tmi.12790

Cited by 33 publications

(46 citation statements)

References 13 publications

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“…Our experience show a high LP acceptance once detailed information was given on its risks and benefits of LP. We also observed cryptococcal meningitis individuals had higher CrAg titers >1:160 as compared with CrAgpositive individuals with no CSF involvement (43% vs 18%) as expected [10,17,[29][30][31].…”

Section: A C C E P T E Dsupporting

confidence: 80%

Laboratory-Reflex Cryptococcal Antigen Screening Is Associated With a Survival Benefit in Tanzania

Faini

Kalinjuma

Katende

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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26This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC) , where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. ABSTRACTBackground: Cryptococcal antigen (CrAg) screening in persons with advanced HIV/AIDS is recommended to prevent death. Implementing CrAg screening only in outpatients may underestimate the true CrAg prevalence and decrease its potential impact. Our previous 12month survival/retention in CrAg-positive persons not treated with fluconazole was 0%.Methods: HIV testing was offered to all ART-naive outpatients and hospitalized patients in Ifakara, Tanzania, followed by laboratory-reflex CrAg screening for CD4<150 cells/µL. CrAgpositive individuals were offered lumbar punctures, and antifungals were tailored to the presence/absence of meningitis. We assessed the impact on survival and retention-in-care using multivariate Cox regression models. Results:We screened 560 individuals for CrAg. The median CD4 count was 61 cells/µL (IQR 26-103). CrAg prevalence was 6.1% (34/560) among individuals with CD4 ≤150 and 7.5% among ≤100 cells/µL. CrAg prevalence was 2.3-fold higher among hospitalized participants than in outpatients (12% vs. 5.3%, p=0.02). We performed lumbar punctures in 94% (32/34), and 31% (10/34) had cryptococcal meningitis. Mortality did not differ significantly between treated CrAg-positive without meningitis and CrAg-negative individuals (7.3 vs 5.4 deaths per 100persons-year, respectively, p=0.25). Independent predictors of 6-month death/lost to follow-up A C C E P T E D 27 were low CD4, cryptococcal meningitis (adjusted hazard ratio (aHR) 2.76, 95% CI 1.31-5.82)), and no ART initiation (aHR 3.12, 95%CI 2.16-4.50). Conclusions:Implementing laboratory-reflex CrAg screening among outpatients and hospitalized-individuals resulted in a rapid detection of cryptococcosis and a survival benefit.These results provide a model of a feasible, effective and scalable CrAg screening and treatment strategy integrated into routine care in sub-Saharan Africa.

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Section: A C C E P T E Dsupporting

confidence: 80%

Laboratory-Reflex Cryptococcal Antigen Screening Is Associated With a Survival Benefit in Tanzania

Faini

Kalinjuma

Katende

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…This study found a CrAg-positive prevalence of 3.1%, but did not perform LP to exclude isolated antigenemia. 16 The present study recruiting only inpatients found 4.8% Regarding baseline characteristics, we did not find difference in CD4 cell count between CrAg-positive and CrAg-negative patients (29 × 56 cells/mm 3 ), like the Vietnam group, 14 but we found statistic difference between those with or without cryptococcal meningitis.…”

Section: Discussioncontrasting

confidence: 63%

“…Another Brazilian study conducted in state of Sao Paulo, Southeast Region, analysed HIV‐infected asymptomatic outpatients, with CD4 counts <200 cells/mm 3 . This study found a CrAg‐positive prevalence of 3.1%, but did not perform LP to exclude isolated antigenemia . The present study recruiting only inpatients found 4.8% (4/83) of isolated antigenemia after excluding cases of meningitis and fungemia by lumber puncture and blood culture.…”

Section: Discussionmentioning

confidence: 91%

“…7,[11][12][13][14][15] In Brazil, two prevalence studies have been published in the Brazilian states of Sao Paulo and Para, with prevalence of 3.1% and 2.6%, respectively. 16,17 This study aimed to describe clinical and laboratorial features of cryptococcosis and HIV and to enlarge Brazilian data by evaluating CrAg prevalence, isolated antigenemia and cryptococcal meningitis in hospitalised patients of a HIV reference centre at INI-FIOCRUZ in Rio de Janeiro, Southeast Brazil.…”

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confidence: 99%

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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

Ferreira

Brito‐Santos

Trilles

et al. 2019

Mycoses

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Summary Cryptococcal meningitis is a several disease common in late stage of HIV infection. Detection of cryptococcal antigen (CrAg) is an important for early diagnosis of this invasive mycosis. The pre‐emptive treatment for isolated antigenemia prevents the onset of meningoencephalitis. Screening CrAg in patients with low CD4 count is cost‐effective in countries with prevalence of antigenemia above 3%. However, in Brazil, the number of prevalence studies on cryptococcosis and HIV is insufficient. The objective of this study is to estimate the prevalence of CrAg and describe clinical characteristics from a cohort of patients followed at a reference center in Brazil. CrAg screening was performed in 89 inpatients with CD4 count ≤200 cells/mm3 or WHO stage III/IV from the National Institute of Infecttious Disease, Rio de Janeiro. Patients with isolated antigenemia received pre‐emptive therapy with fluconazole and patients with meningoencephalitis were treated with Amphotericin B. Individuals were followed up for 12 months. Prevalence of serum CrAg was 11.23%, cryptococcal meningoencephalitis 6.74% and isolated antigenemia 4.81%. None of the patients with isolated antigenemia developed meningoencephalitis during the follow up. Signs and symptoms of meningoencephalitis were unspecific or absent. Our study suggests the need of CrAg screening in Brazil and highlights that lumbar puncture is mandatory in all individuals CrAg positive to exclude asymptomatic meningoencephalitis.

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“…In other African and American studies, it was also found in HIV/AIDS patients with CD4 + T cell lymphocyte count between 100-200 cells/µl. 5,6 This study aim to determine the proportion of Cryptococcal antigenemia in HIV/AIDS patients treated at Dr. Soetomo Hospital Surabaya.…”

Section: Kata Kunci: Cryptococcal Antigenemia Aids Hiv Rsud Dr Somentioning

confidence: 99%

CRYPTOCOCCAL ANTIGENEMIA IN HIV/AIDS PATIENTS USING LATERAL FLOW IMMUNOASSAY DETECTION AT Dr. SOETOMO GENERAL HOSPITAL SURABAYA

Widjaja

Triyono

Kawilarang

et al. 2018

IJTID

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Cryptococcus infection in HIV / AIDS patients results in cryptococcal meningitis, a major cause of subacute meningitis with 100% mortality if not receiving appropriate antifungal therapy. An examination of cryptococcal antigen will provide risk information for patients who will experience cryptococcal meningitis. Better diagnosis in asymptomatic and symptomatic phases of cryptococcosis are key components to reduce morbidity and mortality. This study aims to determine the proportion of cryptococcal antigenemia in HIV / AIDS patients treated at Intermediate Treatment-Infectious Diseases Unit of Dr. Soetomo General Hospital Surabaya. Cryptococcal antigenemia was examined in HIV / AIDS patients with suspected Cryptococcus infection and CD4+ T cell lymphocyte count <200 cell /μl. The examination used a lateral flow assay diagnostic tool, a simple FDA(Food and Drug Administration)-approved immunochromatographic test system for detection of capsular polysccharide antigens of Cryptococcus species complex (Cryptococcus neoformans and Cryptococcus gattii) in blood. This test meets all of the World Health Organization ASSURED criteria (affordable, sensitive, specific, user friendly, rapid/robust, equipment-free, and delivered). Sensitivity and specifiticy of this method from serum are both 100%. There were 3 positive cryptococcal antigenemia from 41 serum HIV / AIDS patients with suspected cryptococcus infection at Intermediate Treatment- Infectious Diseases Unit of Dr. Soetomo General Hospital Surabaya. All of these patients were male aged over 36 years, had CD4+ T cell lymphocytes <100 cell /μl and had never received antiretroviral therapy before. The proportion of cryptococcal antigenemia in HIV / AIDS patients with suspected Cryptococcus infection at Intermediate Treatment-Infectious Diseases Unit of Dr. Soetomo General Hospital Surabaya was 7.32%.

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Asymptomatic cryptococcal antigen prevalence detected by lateral flow assay in hospitalised HIV‐infected patients in São Paulo, Brazil

Cited by 33 publications

References 13 publications

Laboratory-Reflex Cryptococcal Antigen Screening Is Associated With a Survival Benefit in Tanzania

Laboratory-Reflex Cryptococcal Antigen Screening Is Associated With a Survival Benefit in Tanzania

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

CRYPTOCOCCAL ANTIGENEMIA IN HIV/AIDS PATIENTS USING LATERAL FLOW IMMUNOASSAY DETECTION AT Dr. SOETOMO GENERAL HOSPITAL SURABAYA

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