Prevalence of Cryptococcaemia in HIV Seropositive Patients in an Indian Setting

Vijay, Swati; Ingole, Nayana; Wanjare, Shashir; Mehta, Preeti

doi:10.7860/jcdr/2019/40763.12904

Cited by 5 publications

(10 citation statements)

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“…The serum CrAg positivity in patients with advanced HIV disease was 15.49% in our cohort which was very high compared to other studies from India but lower than some studies from Africa [20,21]. There is a marked regional variation in the prevalence of serum cryptococcemia in India with 0% in the southern state of Kerala [8], 2.67–8% in western India [9,10,12,15], 3.1–6.8% in Delhi [11,13,14], 9.6–12.56% in Northeast and Eastern India [16,17]. This variation may be attributed to geographical and soil habitats.…”

Section: Discussioncontrasting

confidence: 59%

“…However, data on the frequency of this potentially preventable disease in India is limited. In recent studies from India, the prevalence of cryptococcal antigenemia varies from 0 to 12.5%; highest in the North East and Eastern region and least in the southern part of the country [8][9][10][11][12][13][14][15][16][17]. None of these studies have systematically screened for serum CrAg followed by CSF testing in those positive.…”

Section: Introductionmentioning

confidence: 99%

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Screening for cryptococcal antigen in asymptomatic people with HIV: urgent need in Eastern India

Chakravarty,

Reddy,

Gupta

et al. 2023

Aids

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Objective: Cryptococcal meningitis (CM) is a leading cause of mortality in people living with HIV (PLHIV). Despite recommendation by the National programme, Cryptococcal Antigen (CrAg) screening in PLHIV with CD4 <200/μL has not been implemented in practice. Therefore, we did a prospective study in government funded Antiretroviral treatment centre to determine the prevalence of asymptomatic cryptococcal antigenemia in PLHIV with CD4 count <200 cells/μL, subclinical cryptococcal meningitis in serum CrAg positive subjects and their outcome. Method: Serum CrAg (BIOSYNEX® CryptoPS) screening was done in newly diagnosed asymptomatic retro-positive adults with CD4 < 200/μL between January 2021- March 2022. We also did CSF CrAg testing in all PLHIV who were serum CrAg positive and appropriate therapy was instituted. All the enrolled participants were followed up till February 2023. Result: Among enrolled 142 PLHIV patients, 22 (15.49%) were positive for serum CrAg. Among these 22, seven (31.8%) patients had CD4 counts between 100-199 cells/μL. CSF CrAg was positive in 11 (50%) serum CrAg positive cases. Serum CrAg positivity was significantly associated with low CD4 cell counts, poor clinical stage and concomitant Pneumocystis pneumonia. However, mortality was not significantly different in Serum CrAg positive and negative PLHIV. None of the deaths in CrAg positive PLHIV was due to cryptococcal disease. Conclusion: Higher prevalence of cryptococcal antigenemia and subclinical CM among PLHIV with CD4 count < 200 cells/μL with good treatment outcomes with therapy reiterates the need for CrAg screening among PLHIV in Eastern India.

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Section: Discussioncontrasting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Screening for cryptococcal antigen in asymptomatic people with HIV: urgent need in Eastern India

Chakravarty,

Reddy,

Gupta

et al. 2023

Aids

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“…Candidiasis and cryptococcosis are opportunistic fungal infections caused by Candida species and Cryptococcus species. The very high prevalence of candidiasis and cryptococcosis has been reported in Indian AIDS patients by various workers [1][2][3][4] . Moreover, treating physicians have encountered a new challenge with the appearance of nonalbicans Candida species as common human pathogens [24] .…”

Section: Compound Fmentioning

confidence: 96%

“…The mortality rate of HIV-associated cryptococcosis in developed countries is 10-30% while in developing countries, it is 13-44%. In India, recently its prevalence rate was reported to be 6-8% among AIDS patients [3,4] . The existing drugs for the treatment of cryptococcosis include amphotericin B, fluconazole, clotrimazole, ketoconazole, 5-flurocytocin, miconazole, and azole derivatives.…”

Section: Introductionmentioning

confidence: 99%

In vitro antifungal activity and phytochemical analysis of lichen Parmelia perlata (L.) Ach.

Singh¹,

Singh²

2020

Int. J. Pharmacognosy Life Sci.

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Fungal diseases like candidiasis and cryptococcosis are the commonest opportunistic infections. Since the difficulties associated with the management of antifungal infections, there is an urgent need for the development of new and effective antifungal agents. In this perspective, natural products are a viable alternative source. The lichen Parmelia perlata, commonly known as stone flower, is traditionally used in the Indian system of medicine. The aim of the present study was to evaluate in vitro antifungal activity of petroleum ether extract of Parmelia perlata against Candida albicans, Candida glabrata, Candida krusei, Candida tropicalis, and Cryptococcus neoformans and its phytochemical analysis. The anti-fungal activity of the extract of Parmelia perlata was determined by measuring the Minimal Inhibitory Concentration (MIC) and Minimum Fungicidal Concentration (MFC) by microbroth dilution method as per the CLSI (NCCLS M27-A2) guidelines. The extract of Parmelia perlata showed the MIC and MFC against Candida species between 600±28µg/ml to 690±16µg/ml and between 750±90µg/ml to 820±45µg/ml, respectively. In addition, the respective values against Cryptococcus neoformans were 550±17µg/ml and 690±34µg/ml, respectively. Further, Parmelia perlata has yielded an acid named-(+)-6-deacetyl-9b-carbmethoxy-9b-dimethylusnic acid and, a quinine named -6-acetyl-11-carbmethoxy-1,4,7,10-tetrahydroxy-2,8-dimethyl naphthacene-5,12-quinone, which were identified on the basis of spectroscopic studies as 2-acetyl-9b-carbmethoxy-7,9-dihydroxy-8-methyl-1,3(2H,9bH)-dibenzofurandione and naphthacene-5,12-quinone derivative, along with four well known compounds-tridecyl myristate, 3-ketooleanane, arachidyl alcohol and (+) usnic acid, respectively. The results of this study showed that Parmelia perlata is a promising antifungal agent.

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“…Pooled estimated proportions of OIs among PLHIV in India ranks tuberculosis (TB) as the major OI (56.7%) with CM at 4.3% 12. The prevalence of cryptococcal antigenaemia among adults with CD4 cells <100 cells/mm 3 varied between 0% and 12.6% in the studies from India 13–18…”

Section: Introductionmentioning

confidence: 99%

Implementation of point-of-care testing and prevalence of cryptococcal antigenaemia among patients with advanced HIV disease in Mumbai, India

et al. 2023

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ObjectivesTo describe the implementation of screening for cryptococcal antigenaemia by point-of-care (POC) serum cryptococcal antigen (CrAg) lateral flow assay, measure the prevalence and factors associated with serum cryptococcal antigenaemia in the routine programmatic setting.DesignCross-sectional study.SettingSeventeen publicly funded antiretroviral therapy (ART) centres in Mumbai, India.ParticipantsSerum CrAg screening was offered to all adolescents (>10 years of age) and adults with advanced HIV disease (AHD) (CD4 <200 cells/mm3or with WHO clinical stage III/IV) regardless of symptoms of cryptococcal meningitis.Primary and secondary outcome measuresThe primary outcome was to describe the implementation of serum CrAg screening and secondary outcome was to measure the prevalence of serum cryptococcal antigenaemia and its risk factors.ResultsA total of 2715 patients with AHD were tested for serum CrAg by POC assay. Of these, 25 (0.9%) had a CrAg positive result. Among CrAg-positive patients, only one had symptoms. Serum CrAg positivity was 3.6% (6/169) and 1.6% (6/520) among those presenting with CD4 <100 cells/mm3in the treatment naïve and treatment experienced group, respectively. On multivariable analysis, CD4 count <100 cells/mm3(OR: 2.3, 95% CI 1.01 to 5.3; p=0.05) and people living with HIV who were treatment naïve (OR: 2.5, 95% CI 1.04 to 6.0; p=0.04) were significantly associated with a positive serum CrAg result. Lumbar puncture was obtained in 20/25 patients within 4 days (range: 1–4 days) of positive serum CrAg result and one person was confirmed to have meningitis. All serum CrAg-positive patients who had a negative cerebrospinal fluid CrAg were offered pre-emptive therapy.ConclusionsImplementation of a POC CrAg assay was possible with existing ART centre staff. Initiation of pre-emptive therapy and management of cryptococcal antigenaemia are operationally feasible at ART centres. The Indian National AIDS Control Programme may consider reflexive CrAg screening of all AHD patients with CD4 <100 cells/mm3.

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Prevalence of Cryptococcaemia in HIV Seropositive Patients in an Indian Setting

Cited by 5 publications

References 0 publications

Screening for cryptococcal antigen in asymptomatic people with HIV: urgent need in Eastern India

Screening for cryptococcal antigen in asymptomatic people with HIV: urgent need in Eastern India

In vitro antifungal activity and phytochemical analysis of lichen Parmelia perlata (L.) Ach.

Implementation of point-of-care testing and prevalence of cryptococcal antigenaemia among patients with advanced HIV disease in Mumbai, India

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