Cryptococcal Antigen Screening and Early Antifungal Treatment to Prevent Cryptococcal Meningitis

Kaplan, Jonathan E.; Vallabhaneni, Snigdha; Smith, Rachel M.; Chideya-Chihota, Sekai; Chehab, Joel; Park, Benjamin

doi:10.1097/qai.0000000000000484

Cited by 50 publications

(40 citation statements)

References 27 publications

(40 reference statements)

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“…This might be supported by genotyping studies that dealt with the ubiquitous nature of Cryptococcus species providing strong evidence for additional origins of exposure like different species of plants, soil, and house dust (Chen et al, 2015;Cogliati, 2013 & Harrison, 2010;Makadzange & McHugh, 2014). In addition to this, those that were hospitalized for different reasons were at a significant risk of cryptococcal infections (Kaplan et al, 2015). In this study, higher prevalence of CrAg was observed in peoples with advanced immune-suppression, which is supported by other similar studies, and WHO recommendations (Alemu et al, 2013;Ganiem et al, 2014;Osazuwa et al, 2012;Pongsai et al, 2010;Randhawa et al, 2011;Sawadogo et al, 2016;Smith et al, 2013;World Health Organization, 2011).…”

Section: Discussionmentioning

confidence: 90%

“…From the sign and symptoms, nausea and vomiting were observed in most of the participants tested positive in contrary to other studies (Hashimoto e Souza et al, ; Jarvis, Meintjes, Williams, Rebe, & Harrison, ; Makadzange & McHugh, ). In addition to this, those that were hospitalized for different reasons were at a significant risk of cryptococcal infections (Kaplan et al, ). In this study, higher prevalence of CrAg was observed in peoples with advanced immune‐suppression, which is supported by other similar studies, and WHO recommendations (Alemu et al, ; Ganiem et al, ; Osazuwa et al, ; Pongsai et al, ; Randhawa et al, ; Sawadogo et al, ; Smith et al, ; World Health Organization, ).…”

Section: Discussionmentioning

confidence: 99%

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Cryptococcal antigenemia and associated risk factors among ART‐naïve and ART‐experienced HIV‐infected peoples at selected health institutions of Mekelle, Northern Ethiopia

et al. 2018

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Cryptococcal infection is a major cause of opportunistic infection in HIV/AID‐infected peoples. We determined cryptococcal antigenemia and cryptococcal meningitis among antiretroviral therapy (ART) initiated and ART‐naive HIV‐infected peoples. A cross‐sectional study was conducted at selected health facilities in Mekelle, Ethiopia. Blood was collected to determine CD4 and plasma cryptococcal antigen (CrAg). CSF CrAg and CSF culture and urease tests were also done. Socio‐demographic and clinical data were collected using a structured questionnaire and clinical chart review. From the enrolled study participants, 267 study participants had complete data, of which, 137 (51%) were females. From the study participants, 140 (52%) and 127 (48%) were ART experienced and ART naïve, respectively. The prevalence of cryptococcal antigenemia was 9 (3.4%). All the study participants, except one (CD4 = 120 cells/mm 3 ), had CD4 count less than 100 cells/mm 3 . From CrAg‐positive peoples, 6 (4.7%) were ART naïve. Five CrAg‐positive peoples had cryptococcal meningitis. Being male, rural residence, and being hospitalized were associated with cryptococcal antigenemia. Cryptococcal infection poses a substantial risk of HIV‐positive peoples. This study provides relevant data for CrAg screening interventions in patients with low CD4 cell counts.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Cryptococcal antigenemia and associated risk factors among ART‐naïve and ART‐experienced HIV‐infected peoples at selected health institutions of Mekelle, Northern Ethiopia

et al. 2018

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“…Routine screening sCrAg has been advocated for HIV‐infected patients at entry into care and prior to antiretroviral therapy in areas with high rates of cryptococcal infection . Whether similar baseline screening should be applied to patients on chemotherapy has not previously been explored in the literature.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcus neoformans infection in malignancy

Schmalzle

Buchwald

Gilliam

et al. 2016

Mycoses

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Cryptococcosis is an opportunistic invasive fungal infection that is well described and easily recognised when it occurs as meningitis in HIV-infected persons. Malignancy and its treatment may also confer a higher risk of infection with Cryptococcus neoformans, but this association has not been as well described. A case of cryptococcosis in a cancer patient is presented, and all cases of coincident C. neoformans infection and malignancy in adults published in the literature in English between 1970 and 2014 are reviewed. Data from these cases were aggregated in order to describe the demographics, type of malignancy, site of infection, clinical manifestations, treatment and outcomes of cryptococcosis in patients with cancer. Haematologic malignancies accounted for 82% of cases, with lymphomas over-represented compared to US population data (66% vs. 53% respectively). Cryptococcosis was reported rarely in patients with solid tumours. Haematologic malignancy patients were more likely to have central nervous system (P < 0.001) or disseminated disease (P < 0.001), receive Amphotericin B as part of initial therapy (P = 0.023), and had higher reported mortality rates than those with solid tumours (P = 0.222). Providers should have heightened awareness of the possibility of cryptococcosis in patients with haematologic malignancy presenting with infection.

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“…In Africa, persons with CD4 cell counts ≤100 cells/ μ l have a reported CRAG prevalence between 2.2% and 21% with an average of 6.8% (95%CI, 6.5–7.2%) in studies including only asymptomatic, ART‐naïve outpatients . In Southeast Asia, CRAG prevalence in asymptomatic ART‐naïve persons with CD4 cell counts ≤100 cells/ μ l is reported in 4–12.9% . The WHO recommends CRAG screening in high prevalence regions, defined as ≥3% based CRAG‐latex agglutination and the cost of amphotericin therapy alone , but other analyses have reported that screening may be cost‐effective even at a prevalence as low as 1% based on the lower cost of CRAG LFA compared to the traditional latex agglutination CRAG .…”

Section: Discussionmentioning

confidence: 99%

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

Vidal

Toniolo

Paulino

et al. 2016

Tropical Med Int Health

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3.1% of HIV-infected inpatients with CD4 <200 cells/μl without symptomatic meningitis had cryptococcal antigenemia in São Paulo, suggesting that routine CRAG screening may be beneficial in similar settings in South America. Our study reveals another targeted population for CRAG screening: hospitalised HIV-infected patients with CD4 <200 cells/μl, regardless of ART status. Whole blood CRAG LFA screening seems to be a simple strategy to prevention of symptomatic meningitis.

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Cryptococcal Antigen Screening and Early Antifungal Treatment to Prevent Cryptococcal Meningitis

Cited by 50 publications

References 27 publications

Cryptococcal antigenemia and associated risk factors among ART‐naïve and ART‐experienced HIV‐infected peoples at selected health institutions of Mekelle, Northern Ethiopia

Cryptococcal antigenemia and associated risk factors among ART‐naïve and ART‐experienced HIV‐infected peoples at selected health institutions of Mekelle, Northern Ethiopia

Cryptococcus neoformans infection in malignancy

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

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