Cryptococcal Antigen Testing in an Integrated Medical System: Eastern Wisconsin

Background Cryptococcosis is a serious opportunistic fungal disease, and the proportion of cases among patients with immunosuppressive conditions other than HIV or organ transplant has increased. Understanding laboratory testing patterns for cryptococcosis is useful for estimating its true burden and developing testing guidance. Methods We identified cryptococcosis tests (cryptococcal antigen [CrAg], cryptococcal antibody, and fungal cultures) performed at a major national commercial laboratory ordered during March 1, 2019–October 1, 2021 and analyzed: test results, patient and provider features, reasons for testing, geography, and temporal trends. Results Among 29,180 serum CrAg tests, 4,422 (15.2%) were positive, and among 10,724 cerebrospinal fluid (CSF) CrAg tests, 492 (4.6%) were positive. Frequent reasons for serum CrAg testing in non-hospital settings (10,882 tests) were HIV (44.6%) and cryptococcosis (17.0%); other underlying conditions were uncommonly listed (<10% total). Serum CrAg positivity declined from 25.6% in October 2019 to 11.3% in September 2021. The South had the highest positivity for serum CrAg tests (16.6%), CSF CrAg tests (4.7%), and fungal cultures (0.15%). Among 5,009 cryptococcal antibody tests, 5 (0.1%) were positive. Conclusions Few outpatient serum CrAg tests were performed for patients with immunocompromising conditions other than HIV, suggesting potential missed opportunities for early detection. Given the high positive predictive value of CrAg testing, research is needed to improve early diagnosis, particularly in patients without HIV. Conversely, the low yield of antibody testing suggests it may be of low value. The decline in CrAg positivity during the COVID-19 pandemic warrants further investigation.

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Testing for Cryptococcosis at a Major Commercial Laboratory—United States, 2019–2021

Benedict

Gold

Dietz

et al. 2022

Open Forum Infectious Diseases

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Cryptococcal Antigen Testing in an Integrated Medical System: Eastern Wisconsin

Abstract: Journal of Patient-Centered Research and Reviews (JPCRR) is a peer-reviewed scientific journal whose mission is to communicate clinical and bench research findings, with the goal of improving the quality of human health, the care of the individual patient, and the care of populations.

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Testing for Cryptococcosis at a Major Commercial Laboratory—United States, 2019–2021

Testing for Cryptococcosis at a Major Commercial Laboratory—United States, 2019–2021

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