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Harrington KRV, Wang YF, Rebolledo PA, Liu Z, Yang Q, Kempker RR. Evaluation of a Cryptococcal Antigen Lateral Flow Assay and Cryptococcal Antigen Positivity at a Large Public Hospital in Atlanta, Georgia. Open Forum Infect Dis 2021; 8:ofab123. [PMID: 34189154 PMCID: PMC8233569 DOI: 10.1093/ofid/ofab123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cryptococcus neoformans is a major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected persons worldwide, and there are scarce recent data on cryptococcal antigen (CrAg) positivity in the United States We sought to determine the frequency of cryptococcal disease and compare the performance of a CrAg lateral flow assay (LFA) versus latex agglutination (LA) test. METHODS All patients from Grady Health System in Atlanta who had a serum or cerebrospinal fluid (CSF) sample sent for CrAg testing as part of clinical care from November 2017 to July 2018 were included. Percentage positivity and test agreement were calculated. RESULTS Among 467 patients, 557 diagnostic tests were performed; 413 on serum and 144 on CSF. The mean age was 44 years, and most were male (69%) and had HIV (79%). Twenty-four (6.4%, 95% confidence interval [CI] = 4.1-9.4) patients were serum CrAg positive, and 8 (5.8%, 95% CI = 2.6-11.2) individuals tested positive for CSF CrAg. Although overall agreement between the LA and LFA was substantial to high for CSF (κ = 0.71, 95% CI = 0.51-0.91) and serum (κ = 0.93, 95% CI = 0.86-1.00), respectively, there were important discrepancies. Five patients had false-positive CSF LA tests that affected clinical care, and 4 patients had discordant serum tests. CONCLUSIONS We found a moderately high proportion of cryptococcal disease and important discrepancies between the LA test and LFA. Clinical implications of these findings include accurate detection of serum CrAg and averting unnecessary treatment of meningitis with costly medications associated with high rates of adverse events.
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Affiliation(s)
- Kristin R V Harrington
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA,Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA,Correspondence: Kristin R. V. Harrington, BS, Department of Epidemiology, Rollins School of Public Health, Emory University, 3rd Floor, Claudia Nance Rollins Building, 1518 Clifton Road, Atlanta, Georgia, USA 30322 ()
| | - Yun F Wang
- Emory University School of Medicine, Department of Pathology & Laboratory Medicine, Atlanta, Georgia, USA,Grady Memorial Hospital, Department of Pathology & Clinical Laboratories, Atlanta, Georgia, USA
| | - Paulina A Rebolledo
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA,Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, USA
| | - Zhiyong Liu
- Grady Memorial Hospital, Department of Pathology & Clinical Laboratories, Atlanta, Georgia, USA
| | - Qianting Yang
- Grady Memorial Hospital, Department of Pathology & Clinical Laboratories, Atlanta, Georgia, USA
| | - Russell R Kempker
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA
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Opportunistic Cryptococcal Antigenemia in the HAART Era at HIV Epidemic Settings of Northwest Ethiopia. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2020; 2020:5017120. [PMID: 32963654 PMCID: PMC7492940 DOI: 10.1155/2020/5017120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/23/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022]
Abstract
Background Cryptococcus neoformans is a frequent opportunistic infection in patients with the acquired immunodeficiency syndrome. While the advent of ART reduces the occurrence of cryptococcal meningitis in HIV patients, cryptococcal disease remains a leading cause of morbidity and mortality in the developing world especially in sub-Saharan Africa which is the epicenter of HIV. This study aimed to assess the cryptococcal antigenemia, CD4+ Th cell counts, HIV RNA viral load, and clinical presentations among HIV-positive patients in Northwest Ethiopia. Method A total of two hundred (200) HIV-positive patients were recruited for this study. Cryptococcus antigenemia prevalence in plasma samples of HIV‐positive patients was determined by using Antigen lateral flow assay (CrAg‐LFA) also, and CD4+ Th cell counts and HIV‐RNA levels were quantified from blood specimen. Patients' demographic data, clinical manifestation, and concurrent opportunistic infection were recorded. Result The sex distributions of study participants were 105(52.5%) male and 94(47.5%) female with an age range of 15–65 (mean 39.42 ± 9) years. All patients had a CD4+ T-cell count <100 cells/µl with the median 54 cells/μl and median HIV-RNA viral load 2.16 × 105 RNA copies/ml (50–3.66 × 105 RNA copies/ml); the prevalence of cryptococcal antigenemia was found to be 4% in HIV-positive patients. More than half and two third of CrAg‐positive patients had a CD4 count <25 cells/μl and HIV viral load >10,000 copies/ml, respectively, as well; Tuberculosis, Candidiasis, and herpes zoster are the most often observed concurrent infections while cryptococcal antigenemia is significantly associated with oral candidiasis (p < 0.001). Conclusion Although the advent of ART, early diagnosis of cryptococcosis, and application of antifungal interventions, HIV-induced cryptococcal antigenemia positivity in HIV infected individuals is still the countries' big challenge. Thus, stringent follow-up and case management should be considered.
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Chukwuanukwu RC, Uchenna N, Mbagwu SI, Chukwuanukwu TO, Charles O. Cryptococcus neoformans seropositivity and some haematological parameters in HIV seropositive subjects. J Infect Public Health 2019; 13:1042-1046. [PMID: 31831399 DOI: 10.1016/j.jiph.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/20/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Cryptococcus neoformans is an opportunistic fungal pathogen that causes meningitis worldwide and may be fatal in immunocompromised subjects. In Nigeria, cases have been reported with prevalence between 4 and 13.1% in Human Immunodeficiency virus (HIV) patients depending on the study subjects. This study was designed to assess the prevalence of cryptococcosis, CD4+T cell counts and possible effect on haematological parameters in HIV seropositive subject in Nnewi, South-Eastern Nigeria. METHOD A total of four hundred and twenty-nine (429) subjects were recruited for the study. Of these, two hundred and ninety (290) were HIV positive and one hundred and thirty-nine (139) were HIV seronegative subjects recruited from the voluntary counseling and testing (VCT) unit and HIV care clinic at Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, Nigeria. Their ages were between 18-80 years. One hundred and thirty nine (139) apparently healthy HIV seronegative subjects were recruited as controls. Blood samples were taken for C. neoformans by Antigen lateral flow assay (CrAgLFA), HIV testing, CD4+T cell, platelet and Full blood count (FBC). RESULTS Our results show that of the two hundred and ninety (290) who were HIV positive subjects investigated for cryptococcosis, 4 (1.4%) tested positive for CrAg of whom 1(25%) were male and 3(75%) were female. All those with cryptococcosis had their CD4 count below 200 cells/μL, three of them were on ART and one was not. There were significant differences in the CD4 counts (P<0.05) between those infected and not infected with C. neoformans. None of the control group tested positive to cryptococcosis. CONCLUSION Widespread use of anti-retroviral therapy may have reduced C. neoformans infection. However, the threat remains and there may be a possibility that women may be a more vulnerable population.
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Affiliation(s)
- Rebecca C Chukwuanukwu
- Department of Medical Laboratory Science, Nnamdi Azikiwe University, Nnewi Campus, Nigeria.
| | - Nkemjika Uchenna
- Department of Hematology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Smart I Mbagwu
- Department of Anatomy, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
| | | | - Onyenekwe Charles
- Department of Medical Laboratory Science, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
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Geda N, Beyene T, Dabsu R, Mengist HM. Prevalence of Cryptococcal Antigenemia and associated factors among HIV/AIDS patients on second-line antiretroviral therapy at two hospitals in Western Oromia, Ethiopia. PLoS One 2019; 14:e0225691. [PMID: 31805085 PMCID: PMC6894769 DOI: 10.1371/journal.pone.0225691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 11/11/2019] [Indexed: 12/02/2022] Open
Abstract
Background Cryptococcosis is a global public health important infectious disease. HIV infection is the main risk factor estimated to account for 95% of cases in the middle- and low-income countries and 80% of the cases in high-income countries. Objective The main aim of the study was to determine the prevalence and associated risk factors of Cryptococcal antigenemia (CrAg) among HIV/AIDS Patients on second-line ART Therapy at Ambo General Hospital and Nekemte Referral Hospital, Western Oromia, Ethiopia. Materials and methods Hospital-based cross-sectional study was employed from September 1, 2017, to October 30, 2017. Whole blood was tested for CrAg using Cryptococcal lateral flow assay (Immuno-Mycologics, Norman, OK, USA) according to the manufacturer's instructions. The collected data were analyzed using SPSS version 20 software. Binary logistic regression models were applied to assess the association between predictors and outcome variables at 95% CI. Result Among the study participants, 115(62.8%) were females and the median age of the participants was 35 (IQR: 14) years. Majority, 169(92.3%), have been living with HIV for ≥ 5.6 years and 124 (67.8%) stayed on 2nd line ART for an average of 2.5 years. The overall prevalence of Cryptococcal antigenemia in the study participants was 7.7% (14/183). Being male [AOR, 95% CI: 4.78(1.14, 20.1)], poor adherence to ART [AOR, 95% CI: 0.12(0.03, 0.4)], occupational exposures to contaminated soil [AOR, 95% CI: 6.81(1.38, 33.4)], having non-separated house from chickens [AOR, 95% CI: 0.06(0.01, 0.51)], CD4 T+ cell levels ≤ 100 cell/μL [AOR, 95% CI: 6.57(1.9, 23.3)] and viral load >1000 copies/mL [AOR, 95% CI: 11.7(2.4, 57.8)] were significant predictors of Cryptococcal antigenemia (P≤ 0.05). Conclusion The prevalence of Cryptococcal Antigenemia was significantly high in this study. Being male, occupational exposure to contaminated soil with avian droppings, CD4+ T cell levels <100 cell/μL and viral load >1000 copies/mL were significant predictors of Cryptococcal antigenemia. Therefore, public health measures, adherence to ART and early treatment are recommended.
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Affiliation(s)
- Nuguse Geda
- Department of Medical Laboratory Sciences, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tafese Beyene
- Department of Medical Laboratory Sciences, College of Health Sciences, Arsi University, Assela, Ethiopia
| | - Regea Dabsu
- Department of Medical Laboratory Sciences, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Hylemariam Mihiretie Mengist
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
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King KA, Ansari G, Panackal AA, Zalewski C, Anjum S, Bennett JE, Beri A, Kim HJ, Hammoud D, Brewer CC, Williamson PR. Audiologic and Otologic Complications of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Patients. Otol Neurotol 2019; 40:e657-e664. [PMID: 31157723 PMCID: PMC6565454 DOI: 10.1097/mao.0000000000002242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To identify audiologic and otologic outcomes in previously healthy non-HIV patients with cryptococcal meningoencephalitis (CM). STUDY DESIGN Retrospective case review of a subset of patients recruited in a prospective observational study following previously healthy individuals who developed CM. SETTING Tertiary referral center, National Institutes of Health Clinical Center. PATIENTS Previously healthy adult patients with CM without immune suppressive therapy before disease onset. INTERVENTIONS Diagnostic evaluations included audiometry, acoustic immittance, otoacoustic emissions, and auditory brainstem response studies, in addition to neurotologic assessment. RESULTS Twenty-nine patients (58 years) underwent audiologic evaluation between 6 months and 3.5 years after CM diagnosis; 21 patients were seen for longitudinal assessment with an average duration of follow up of 20.3 months. Nearly three-quarters (73%) of the cohort presented with hearing loss, most commonly (90%) sensorineural in origin. The most frequent degree of loss was mild and then moderate, although some patients had severe or profound impairment. Hearing loss improved (43%) or remained stable (38%) in most cases. Ears with internal auditory canal enhancement on magnetic resonance imaging (MRI) had significantly more hearing loss than those without enhancement, although a similar finding was not observed with gyral enhancement or the presence of ependymitis or ventricular volume expansion. Hearing loss was not associated with reduced cerebrospinal fluid (CSF) glucose, CSF total protein, cryptococcal antigen, or total cell count. CONCLUSIONS Hearing loss is a common manifestation of cryptococcal meningitis in previously healthy patients and may involve a cochlear or neural site of lesion, or both. Routine surveillance of hearing in patients is recommended, regardless of symptomatology, to ensure early and appropriate intervention and care.
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Affiliation(s)
- Kelly A King
- National Institute on Deafness and Other Communication Disorders
| | | | - Anil A Panackal
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
| | - Chris Zalewski
- National Institute on Deafness and Other Communication Disorders
| | - Seher Anjum
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
| | - John E Bennett
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
| | - Andrea Beri
- Biomedical Translational Research Information System
| | - Hung Jeff Kim
- National Institute on Deafness and Other Communication Disorders
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Hospital, Washington, DC
| | - Dima Hammoud
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Carmen C Brewer
- National Institute on Deafness and Other Communication Disorders
| | - Peter R Williamson
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
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Ndayishimiye E, Ross AJ. An audit of the screen-and-treat intervention to reduce cryptococcal meningitis in HIV-positive patients with low CD4 count. Afr J Prim Health Care Fam Med 2018; 10:e1-e7. [PMID: 30198285 PMCID: PMC6131693 DOI: 10.4102/phcfm.v10i1.1779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV-associated cryptococcal meningitis (CCM) and related mortality may be prevented by the effective implementation of a screen-and-treat intervention. Aim: The aim of this study was to assess the effectiveness of the screen-and-treat intervention at a regional hospital in KwaZulu-Natal province, South Africa. Method: This was a descriptive study in which the records of patients seen in 2015 and 2016 with a CD4 count ≤ 100 cell/mm3 were retrieved from National Health Laboratory Service (NHLS) records and matched against patients admitted for HIV-associated CCM. Results: A total of 5.1% (190 out of 3702) patients with CD4 count ≤ 100 cell/mm3 were cryptococcal antigen positive (CrAg +ve), of whom 22.6% (43 out of 190) were admitted with CCM. Patients who were CrAg +ve had significantly lower CD4 counts (mean CD4 = 38.9 ± 28.5) when compared to CrAg -ve patients (mean CD4 = 49.9 ± 37.4) with p = 0.0001. Only 2.6% (5 out of 190) of patients were referred for a lumbar puncture (LP) as part of the screen-and-treat intervention, whilst 38 who were CrAg +ve self-presented with CCM. Eighty-eight patients were admitted for suspected CCM: eight because of the screen-and-treat-intervention (none of whom had meningitis based on cerebrospinal fluid results) and 80 of whom self-presented and had confirmed CCM. The overall mortality of patients admitted with CCM was 30% (24 out of 80). Conclusion: The current ad-hoc screen-and-treat intervention was ineffective in detecting patients at risk of developing CCM. Systems need to be put in place to ensure that all CrAg +ve patients have an LP to detect subclinical CCM to improve the outcome for those with HIV-associated CCM.
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Affiliation(s)
- Egide Ndayishimiye
- Health, College of Health Sciences, University of KwaZulu-Natal, Prince Mshiyeni Memorial Hospital.
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Ford N, Shubber Z, Jarvis JN, Chiller T, Greene G, Migone C, Vitoria M, Doherty M, Meintjes G. CD4 Cell Count Threshold for Cryptococcal Antigen Screening of HIV-Infected Individuals: A Systematic Review and Meta-analysis. Clin Infect Dis 2018; 66:S152-S159. [PMID: 29514236 PMCID: PMC5850628 DOI: 10.1093/cid/cix1143] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Current guidelines recommend screening all people living with human immunodeficiency virus (PLHIV) who have a CD4 count ≤100 cells/µL for cryptococcal antigen (CrAg) to identify those patients who could benefit from preemptive fluconazole treatment prior to the onset of meningitis. We conducted a systematic review to assess the prevalence of CrAg positivity at different CD4 cell counts. Methods We searched 4 databases and abstracts from 3 conferences up to 1 September 2017 for studies reporting prevalence of CrAg positivity according to CD4 cell count strata. Prevalence estimates were pooled using random effects models. Results Sixty studies met our inclusion criteria. The pooled prevalence of cryptococcal antigenemia was 6.5% (95% confidence interval [CI], 5.7%-7.3%; 54 studies) among patients with CD4 count ≤100 cells/µL and 2.0% (95% CI, 1.2%-2.7%; 21 studies) among patients with CD4 count 101-200 cells/µL. Twenty-one studies provided sufficient information to compare CrAg prevalence per strata; overall, 18.6% (95% CI, 15.4%-22.2%) of the CrAg-positive cases identified at ≤200 cells/µL (n = 11823) were identified among individuals with a CD4 count 101-200 cells/µL. CrAg prevalence was higher among inpatients (9.8% [95% CI, 4.0%-15.5%]) compared with outpatients (6.3% [95% CI, 5.3%-7.4%]). Conclusions The findings of this review support current recommendations to screen all PLHIV who have a CD4 count ≤100 cells/µL for CrAg and suggest that screening may be considered at CD4 cell count ≤200 cells/µL.
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Affiliation(s)
- Nathan Ford
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Zara Shubber
- Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom
| | - Joseph N Jarvis
- Botswana-UPenn Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Greg Greene
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chantal Migone
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Marco Vitoria
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Graeme Meintjes
- Wellcome Trust Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
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Oladele RO, Bongomin F, Gago S, Denning DW. HIV-Associated Cryptococcal Disease in Resource-Limited Settings: A Case for "Prevention Is Better Than Cure"? J Fungi (Basel) 2017; 3:jof3040067. [PMID: 29371581 PMCID: PMC5753169 DOI: 10.3390/jof3040067] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/21/2017] [Accepted: 11/30/2017] [Indexed: 11/18/2022] Open
Abstract
Cryptococcal disease remains a significant source of global morbidity and mortality for people living with HIV, especially in resource-limited settings. The recently updated estimate of cryptococcal disease revealed a global incidence of 223,100 cases annually with 73% of these cases being diagnosed in sub-Saharan Africa. Furthermore, 75% of the estimated 181,100 deaths associated with cryptococcal disease occur in sub-Saharan Africa. Point-of-care diagnostic assays have revolutionised the diagnosis of this deadly opportunistic infection. The theory of asymptomatic cryptococcal antigenaemia as a forerunner to symptomatic meningitis and death has been conclusively proven. Thus, cryptococcal antigenaemia screening coupled with pre-emptive antifungal therapy has been demonstrated as a cost-effective strategy with survival benefits and has been incorporated into HIV national guidelines in several countries. However, this is yet to be implemented in a number of other high HIV burden countries. Flucytosine-based combination therapy during the induction phase is associated with improved survival, faster cerebrospinal fluid sterilisation and fewer relapses. Flucytosine, however, is unavailable in many parts of the world. Studies are ongoing on the efficacy of shorter regimens of amphotericin B. Early diagnosis, proactive antifungal therapy with concurrent management of raised intracranial pressure creates the potential to markedly reduce mortality associated with this disease.
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Affiliation(s)
- Rita O Oladele
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
- Department of Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos ,P.O.Box 132, Nigeria.
- Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland.
| | - Felix Bongomin
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
- Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland.
- The National Aspergillosis Center, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK.
| | - Sara Gago
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
- Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland.
- Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester, Manchester M13 9PL, UK.
| | - David W Denning
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
- Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland.
- The National Aspergillosis Center, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK.
- Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester, Manchester M13 9PL, UK.
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The relentless march of cryptococcal meningitis. THE LANCET. INFECTIOUS DISEASES 2017; 17:790-791. [PMID: 28483416 DOI: 10.1016/s1473-3099(17)30245-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/18/2017] [Indexed: 11/20/2022]
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Ramachandran A, Manabe Y, Rajasingham R, Shah M. Cost-effectiveness of CRAG-LFA screening for cryptococcal meningitis among people living with HIV in Uganda. BMC Infect Dis 2017; 17:225. [PMID: 28335769 PMCID: PMC5364591 DOI: 10.1186/s12879-017-2325-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 03/15/2017] [Indexed: 12/27/2022] Open
Abstract
Background Cryptococcal meningitis (CM) constitutes a significant source of mortality in resource-limited regions. Cryptococcal antigen (CRAG) can be detected in the blood before onset of meningitis. We sought to determine the cost-effectiveness of implementing CRAG screening using the recently developed CRAG lateral flow assay in Uganda compared to current practice without screening. Methods A decision-analytic model was constructed to compare two strategies for cryptococcal prevention among people living with HIV with CD4 < 100 in Uganda: No cryptococcal screening vs. CRAG screening with WHO-recommended preemptive treatment for CRAG-positive patients. The model was constructed to reflect primary HIV clinics in Uganda, with a cohort of HIV-infected patients with CD4 < 100 cells/uL. Primary outcomes were expected costs, DALYs, and incremental cost-effectiveness ratios (ICERs). We evaluated varying levels of programmatic implementation in secondary analysis. Results CRAG screening was considered highly cost-effective and was associated with an ICER of $6.14 per DALY averted compared to no screening (95% uncertainty range: $-20.32 to $36.47). Overall, implementation of CRAG screening was projected to cost $1.52 more per person, and was projected to result in a 40% relative reduction in cryptococcal-associated mortality. In probabilistic sensitivity analysis, CRAG screening was cost-effective in 100% of scenarios and cost saving (ie cheaper and more effective than no screening) in 30% of scenarios. Secondary analysis projected a total cost of $651,454 for 100% implementation of screening nationally, while averting 1228 deaths compared to no screening. Conclusion CRAG screening for PLWH with low CD4 represents excellent value for money with the potential to prevent cryptococcal morbidity and mortality in Uganda.
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Affiliation(s)
- Anu Ramachandran
- Johns Hopkins University School of Medicine, 725 N. Wolfe St. PCTB building-224, Baltimore, MD, 21205, USA
| | - Yukari Manabe
- Johns Hopkins University School of Medicine, 725 N. Wolfe St. PCTB building-224, Baltimore, MD, 21205, USA.,Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Radha Rajasingham
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Maunank Shah
- Johns Hopkins University School of Medicine, 725 N. Wolfe St. PCTB building-224, Baltimore, MD, 21205, USA.
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Pegorie M, Denning DW, Welfare W. Estimating the burden of invasive and serious fungal disease in the United Kingdom. J Infect 2017; 74:60-71. [DOI: 10.1016/j.jinf.2016.10.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 01/07/2023]
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Cogliati M, D'Amicis R, Zani A, Montagna MT, Caggiano G, De Giglio O, Balbino S, De Donno A, Serio F, Susever S, Ergin C, Velegraki A, Ellabib MS, Nardoni S, Macci C, Oliveri S, Trovato L, Dipineto L, Rickerts V, McCormick-Smith I, Akcaglar S, Tore O, Mlinaric-Missoni E, Bertout S, Mallié M, Martins MDL, Vencà ACF, Vieira ML, Sampaio AC, Pereira C, Criseo G, Romeo O, Ranque S, Al-Yasiri MHY, Kaya M, Cerikcioglu N, Marchese A, Vezzulli L, Ilkit M, Desnos-Ollivier M, Pasquale V, Korem M, Polacheck I, Scopa A, Meyer W, Ferreira-Paim K, Hagen F, Theelen B, Boekhout T, Lockhart SR, Tintelnot K, Tortorano AM, Dromer F, Varma A, Kwon-Chung KJ, Inácio J, Alonso B, Colom MF. Environmental distribution of Cryptococcus neoformans and C. gattii around the Mediterranean basin. FEMS Yeast Res 2016; 16:fow045. [PMID: 27188887 DOI: 10.1093/femsyr/fow045] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2016] [Indexed: 11/15/2022] Open
Abstract
In order to elucidate the distribution of Cryptococcus neoformans and C. gattii in the Mediterranean basin, an extensive environmental survey was carried out during 2012-2015. A total of 302 sites located in 12 countries were sampled, 6436 samples from 3765 trees were collected and 5% of trees were found to be colonized by cryptococcal yeasts. Cryptococcus neoformans was isolated from 177 trees and C. gattii from 13. Cryptococcus neoformans colonized 27% of Ceratonia, 10% of Olea, Platanus and Prunus trees and a lower percentage of other tree genera. The 13 C. gattii isolates were collected from five Eucalyptus, four Ceratonia, two Pinus and two Olea trees. Cryptococcus neoformans was distributed all around the Mediterranean basin, whereas C. gattii was isolated in Greece, Southern Italy and Spain, in agreement with previous findings from both clinical and environmental sources. Among C. neoformans isolates, VNI was the prevalent molecular type but VNII, VNIV and VNIII hybrid strains were also isolated. With the exception of a single VGIV isolate, all C. gattii isolates were VGI. The results confirmed the presence of both Cryptococcus species in the Mediterranean environment, and showed that both carob and olive trees represent an important niche for these yeasts.
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Affiliation(s)
- Massimo Cogliati
- Dip. Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - Roberta D'Amicis
- Dip. Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - Alberto Zani
- Dip. Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - Maria Teresa Montagna
- Dip. Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppina Caggiano
- Dip. Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Osvalda De Giglio
- Dip. Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Stella Balbino
- Dip. Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Antonella De Donno
- Dip. di Scienze e Tecnologie Biologiche ed Ambientali, Università del Salento, Via Monteroni, 73100 Lecce, Italy
| | - Francesca Serio
- Dip. di Scienze e Tecnologie Biologiche ed Ambientali, Università del Salento, Via Monteroni, 73100 Lecce, Italy
| | - Serdar Susever
- Dept. of Nutrition and Dietetics, Cyprus Near East University, Near East Boulevard, 99138 Nicosia, Cyprus
| | - Cagri Ergin
- Medical School, Pamukkale University, Kliniki Kampusu, 20160 Denizli, Turkey
| | - Aristea Velegraki
- Medical School National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece
| | - Mohamed S Ellabib
- Medical College, University of Tripoli, Tripoli University Road, Tripoli, Libya
| | - Simona Nardoni
- Dip. Scienze Veterinarie, Università di Pisa, Via delle Piagge 2, 56124 Pisa, Italy
| | - Cristina Macci
- Istituto per lo Studio degli Ecosistemi (ISE), National Research Council (CNR), Via Moruzzi 1, 56124 Pisa, Italy
| | - Salvatore Oliveri
- Dip. di Scienze Microbiologiche e Scienze Ginecologiche, Università degli Studi di Catania, Via Androne 81, 95124 Catania, Italy
| | - Laura Trovato
- Dip. di Scienze Microbiologiche e Scienze Ginecologiche, Università degli Studi di Catania, Via Androne 81, 95124 Catania, Italy
| | - Ludovico Dipineto
- Dip. di Medicina Veterinaria e Produzioni Animali, University of Napoli Federico II, C.so Umberto I 40, 80138 Napoli, Italy
| | - Volker Rickerts
- Dept. of Infeciuos Diseases, Robert-Koch Institute, D-13302 Berlin, Germany
| | | | - Sevim Akcaglar
- School of Medicine, Uludag University, Gorukle Kampusu, 16059 Bursa, Turkey
| | - Okan Tore
- School of Medicine, Uludag University, Gorukle Kampusu, 16059 Bursa, Turkey
| | | | - Sebastien Bertout
- Unité Mixte Internationale 'Recherches Translationnelles sur l'infection à VIH et les Maladies Infectieuses', Université de Montpellier, 15 Avenue Charles Flahault, 34093 Montpellier, France
| | - Michele Mallié
- Unité Mixte Internationale 'Recherches Translationnelles sur l'infection à VIH et les Maladies Infectieuses', Université de Montpellier, 15 Avenue Charles Flahault, 34093 Montpellier, France
| | - Maria da Luz Martins
- Instituto de Higiene e Medicina Tropical, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Ana C F Vencà
- Instituto de Higiene e Medicina Tropical, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Maria L Vieira
- Instituto de Higiene e Medicina Tropical, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Ana C Sampaio
- CITAB, Universidade de Trás-os-Montes e Alto Douro, Quinta dos Prados, 5000-801 Vila Real, Portugal
| | - Cheila Pereira
- CITAB, Universidade de Trás-os-Montes e Alto Douro, Quinta dos Prados, 5000-801 Vila Real, Portugal
| | - Giuseppe Criseo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Piazza Pugliatti 1, 98122 Messina, Italy
| | - Orazio Romeo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Piazza Pugliatti 1, 98122 Messina, Italy
| | - Stéphane Ranque
- IP-TPT Infections Parasitaires Transmission Pphysiopathologie et Therapeutiques, Aix-Marseille University, 27 Blv. Jean Moulin, 13005 Marseille, France
| | - Mohammed H Y Al-Yasiri
- IP-TPT Infections Parasitaires Transmission Pphysiopathologie et Therapeutiques, Aix-Marseille University, 27 Blv. Jean Moulin, 13005 Marseille, France
| | - Meltem Kaya
- School of Medicine, Marmara University, MÜ Göztepe Kampüsü, 34722 Istanbul, Turkey
| | - Nilgun Cerikcioglu
- School of Medicine, Marmara University, MÜ Göztepe Kampüsü, 34722 Istanbul, Turkey
| | - Anna Marchese
- Sezione di Microbiologia del DISC, Università di Genova-IRCCS San Martino IST Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Luigi Vezzulli
- Dipartimento di Scienze della Terra, dell'Ambiente e della Vita (DISTAV), Università di Genova, C.so europa 26, 16132 Genova, Italy
| | - Macit Ilkit
- Dept. of Microbiology, University of Çukurova Sariçam, Çukurova Üniversitesi Rektörlüğü, 01330 Adana, Turkey
| | - Marie Desnos-Ollivier
- Institut Pasteur, CNRS, Unité de Mycologie Moléculaire, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Vincenzo Pasquale
- Dip. di Scienze e Tecnologie, Università degli Studi di Napoli Parthenope, Via Amm. F. Acton 38, 80133 Napoli, Italy
| | - Maya Korem
- Div. of Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein Kerem, P.O. Box 12271 Jerusalem, Israel
| | - Itzhack Polacheck
- Div. of Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein Kerem, P.O. Box 12271 Jerusalem, Israel
| | - Antonio Scopa
- Facoltà di Scienze Agrarie, Forestali e Ambientali, Università degli Studi della Basilicata, Via Nazario Sauro 85, 85100 Potenza, Italy
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, CIDM, MBI, Sydney Medical School-Westmead Hospital, University of Sydney/Westmead Millennium Institute, 176 Hawkesbury Rd, NSW 2145 Westmead, NSW, Australia
| | - Kennio Ferreira-Paim
- Molecular Mycology Research Laboratory, CIDM, MBI, Sydney Medical School-Westmead Hospital, University of Sydney/Westmead Millennium Institute, 176 Hawkesbury Rd, NSW 2145 Westmead, NSW, Australia
| | - Ferry Hagen
- Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
| | - Bart Theelen
- CBS-KNAW Fungal Biodiversity Centre, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - Teun Boekhout
- CBS-KNAW Fungal Biodiversity Centre, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - Shawn R Lockhart
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333 Atlanta, USA
| | - Kathrin Tintelnot
- Dept. of Infeciuos Diseases, Robert-Koch Institute, D-13302 Berlin, Germany
| | - Anna Maria Tortorano
- Dip. Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - Françoise Dromer
- Institut Pasteur, CNRS, Unité de Mycologie Moléculaire, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Ashok Varma
- National Institute of Allergy and Infectious Diseases, 31 Center Dr, Bethesda, MD 20892 Bethesda, USA
| | - Kyung J Kwon-Chung
- National Institute of Allergy and Infectious Diseases, 31 Center Dr, Bethesda, MD 20892 Bethesda, USA
| | - Joäo Inácio
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Lewes Road, BN2 4GJ Brighton, UK
| | - Beatriz Alonso
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Lewes Road, BN2 4GJ Brighton, UK
| | - Maria F Colom
- Medical School, Universidad Miguel Hernández, Avenida de la Universidad, 03202 Alicante, Spain
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Abstract
Cryptococcosis is caused by the fungal genus Cryptococcus. Cryptococcosis, predominantly meningoencephalitis, emerged with the HIV pandemic, primarily afflicting HIV-infected patients with profound T-cell deficiency. Where in use, combination antiretroviral therapy has markedly reduced the incidence of and risk for disease, but cryptococcosis continues to afflict those without access to therapy, particularly in sub-Saharan Africa and Asia. However, cryptococcosis also occurs in solid organ transplant recipients and patients with other immunodeficiencies as well as those with no known immunodeficiency. This article reviews innate and adaptive immune responses to C. neoformans, with an emphasis on recent studies on the role of B cells, natural IgM and Fc gamma receptor polymorphisms in resistance to cryptococcosis.
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Affiliation(s)
- Soma Rohatgi
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
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Greene G, Vallabhaneni S, Chung JH, Chiller T. Cryptococcal Antigen Screening and Treatment: The Current State of Global Screening Programs to Prevent Death from Cryptococcal Infection. CURRENT FUNGAL INFECTION REPORTS 2015. [DOI: 10.1007/s12281-015-0246-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Chen YC, Chang TY, Liu JW, Chen FJ, Chien CC, Lee CH, Lu CH. Increasing trend of fluconazole-non-susceptible Cryptococcus neoformans in patients with invasive cryptococcosis: a 12-year longitudinal study. BMC Infect Dis 2015; 15:277. [PMID: 26194004 PMCID: PMC4509779 DOI: 10.1186/s12879-015-1023-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 07/13/2015] [Indexed: 12/23/2022] Open
Abstract
Background This study aimed to investigate the rate of fluconazole-non-susceptible Cryptococcus neoformans in Southern Taiwan for the period 2001–2012 and analyze the risk factors for acquiring it among patients with invasive cryptococcosis. Methods All enrolled strains were isolated from blood or cerebrospinal fluid samples of the included patients. If a patient had multiple positive results for C. neoformans, only the first instance was enrolled. Susceptibility testing was performed using the Clinical and Laboratory Standards Institutes M27-A3 broth micro-dilution method. The MIC interpretative criteria for susceptibility to fluconazole were ≤8 μg/ml. A total of 89 patients were included. Patients (n = 59) infected by fluconazole-susceptible strains were compared with those (n = 30) infected by non-susceptible strains. The patients’ demographic and clinical characteristics were analyzed. Results The rate of fluconazole-non-susceptible C. neoformans in the study period significantly increased over time (p < 0.001). The C. neoformans isolated in 2011–2012 (odds ratio: 10.68; 95 % confidence interval: 2.87-39.74; p < 0.001) was an independent predictive factor for the acquisition of fluconazole-non-susceptible C. neoformans. Conclusions The rate of fluconazole-non-susceptible C. neoformans has significantly increased recently. Continuous and large-scale anti-fungal susceptibility tests for C. neoformans are warranted to confirm this trend.
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Affiliation(s)
- Yi-Chun Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Tzu-Yao Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Jien-Wei Liu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. .,Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung City, 833, Taiwan.
| | - Fang-Ju Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Chun-Chih Chien
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. .,Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung City, 833, Taiwan.
| | - Cheng-Hsien Lu
- Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung City, 833, Taiwan. .,Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung City, 833, Taiwan. .,Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.
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16
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Abstract
PURPOSE OF REVIEW To review recent studies that address the pathogenesis, diagnosis and treatment of HIV positive patients with cryptococcal and tuberculous meningitis and progressive multifocal leukoencephalopathy in resource-different settings. RECENT FINDINGS Central nervous system opportunistic infections remain globally prevalent in HIV+ populations. Several recent papers have highlighted the urgent need for rapid point of care tests in low-income settings for cryptococcal and tuberculous meningitis, better access to antifungal therapy for cryptococcal meningitis and better treatment strategies for tuberculous meningitis. In one recent study of 299 HIV+ patients with cryptococcal meningitis, amphotericin plus flucytosine was associated with less mortality and disability compared to amphotericin alone. In a study of patients with tuberculous meningitis in Indonesia, short-term, high dose rifampicin and moxifloxacin, designed to achieve higher levels of anti-TB drugs in the brain, saw significantly reduced patient mortality at 6 months. The timing of ART initiation in patients with central nervous system opportunistic infections remains challenging and a recent study reported that deferred vs early antiretroviral therapy was associated with better survival outcomes in patients diagnosed with cryptococcal meningitis. Recent studies have reported on predictors of immune reconstitution inflammatory syndrome for patients with central nervous system opportunistic infections, but require validation in resource-different settings. SUMMARY Recent studies related to the diagnosis and treatment of central nervous system opportunistic infections in HIV+ populations show promising findings. Increased funding and research commitment are required to maintain this positive momentum and to achieve improved global outcomes for people who develop central nervous system opportunistic infections.
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Meya D, Rajasingham R, Nalintya E, Tenforde M, Jarvis JN. Preventing Cryptococcosis-Shifting the Paradigm in the Era of Highly Active Antiretroviral Therapy. CURRENT TROPICAL MEDICINE REPORTS 2015; 2:81-89. [PMID: 25960942 PMCID: PMC4412515 DOI: 10.1007/s40475-015-0045-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cryptococcosis remains a significant cause of morbidity and mortality among HIV-infected patients, especially in sub-Saharan Africa where it causes up to 20 % of AIDS-related deaths in HIV programs. A new, highly sensitive, and affordable point of care diagnostic test for cryptococcal infection, the lateral flow assay, can detect early sub-clinical cryptococcosis especially in areas with limited laboratory infrastructure. With a prevalence of detectable sub-clinical cryptococcal infection averaging 7.2 % (95 % CI 6.8-7.6 %) among 36 cohorts with CD4 <100 cells/μL in Africa, together with data showing that preemptive fluconazole prevents overt cryptococcal disease in this population, implementing a screen and treat strategy as part of HIV care practice among patients with CD4 <100 cells/μL could prevent the incidence of often fatal cryptococcal meningitis in the setting of the HIV pandemic.
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Affiliation(s)
- David Meya
- />Infectious Disease Institute, College of Health Sciences, Makerere University, Mulago Hill Road, # 22418, Kampala, Uganda
- />Department of Medicine, Center for Infectious Diseases and Microbiology Translational Research, University of Minnesota, 450 Delaware Street, MMC250, Minneapolis, MN 55455 USA
- />School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Radha Rajasingham
- />Department of Medicine, Center for Infectious Diseases and Microbiology Translational Research, University of Minnesota, 450 Delaware Street, MMC250, Minneapolis, MN 55455 USA
| | - Elizabeth Nalintya
- />Infectious Disease Institute, College of Health Sciences, Makerere University, Mulago Hill Road, # 22418, Kampala, Uganda
| | - Mark Tenforde
- />Botswana-UPenn Partnership, P.O. Box AC 157 ACH, Gaborone, Botswana
| | - Joseph N Jarvis
- />Botswana-UPenn Partnership, P.O. Box AC 157 ACH, Gaborone, Botswana
- />Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- />London School of Hygiene and Tropical Medicine, London, UK
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18
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Chopra S, Capoor MR, Mallik R, Gupta S, Ray A, Khanna G, Suri JC, Bhattacharya D, Raghavan S. Pulmonary Cryptococcosis in HIV- sero-negative patients: case series from India. Mycoses 2015; 58:288-93. [PMID: 25817989 DOI: 10.1111/myc.12313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 01/15/2015] [Accepted: 02/13/2015] [Indexed: 11/28/2022]
Abstract
Pulmonary cryptococcosis is likely to be misdiagnosed due to relatively non-specific clinical and radiological features. It is more frequently associated with immuno-suppressed conditions especially acquired immuno-deficiency syndrome (AIDS) and pulmonary tuberculosis (PTB). Four cases of pulmonary cryptococcosis were diagnosed over a period of eleven years. All patients in this case series were human immune-deficiency virus (HIV)-negative. The predisposing factors in these patients were diabetes mellitus (DM), acute lymphoblastic leukaemia (ALL), post-partum and pregnancy in one each of the patients. Relapse was seen in two cases. All the patients survived due to strict follow-up. Pulmonary cryptococcosis is common in non-AIDS patients and it warrants rapid diagnosis, treatment and follow-up to prevent relapse.
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Affiliation(s)
- Shimpi Chopra
- Department of Microbiology, V.M.M.C. and Safdarjang Hospital, New Delhi, India
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19
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Katchanov J, Jefferys L, Tominski D, Wöstmann K, Slevogt H, Arastéh K, Stocker H. Cryptococcosis in HIV-infected hospitalized patients in Germany: Evidence for routine antigen testing. J Infect 2015; 71:110-6. [PMID: 25644318 DOI: 10.1016/j.jinf.2015.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/06/2015] [Accepted: 01/11/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the diagnostic value of routine cryptococcal antigen (CRAG) testing in HIV-infected patients in a low prevalence setting. METHODS Retrospective single centre cohort study of a 10-year period (2005-2014). RESULTS 5461 patients tested for CRAG were included. Cryptococcal antigenaemia was found in 1.6% and 1.1% of patients with CD4 counts of ≤100/μl and 101-200/μl, respectively. The positive predictive values for identifying clinically relevant cryptococcal disease was 96% and 100%, respectively. Half of the patients had a non-specific presentation and median time-to-diagnosis was high (5 days, range 1-44 days). The median time-to-diagnosis in direct admissions to our centre with routine CRAG testing was significantly shorter: 1 day (range: 1-17) vs. 7 days (range: 2-44), p = 0.003. Prevalence of cryptococcal antigenaemia was 2.8% in patients with pneumocystis pneumonia and median time-to-diagnosis of cryptococcosis was significantly longer in this subgroup (15 days; range: 1-44 vs. 3 days; range: 1-17; p = 0.008). CRAG titres ≥1:512 were associated with disseminated disease (OR 21.3, p = 0.0008, 95% CI 1.64-277), however, 10% of patients with disseminated cryptococcosis had CRAG titres <1:16. CONCLUSION Our data support routine CRAG testing in hospitalized HIV-infected patients with CD4 counts ≤200/μl, and/or pneumocystis pneumonia.
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Affiliation(s)
- Juri Katchanov
- Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany.
| | - Laura Jefferys
- Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Daniela Tominski
- Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Kai Wöstmann
- Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | | | - Keikawus Arastéh
- Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Hartmut Stocker
- Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
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20
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Rivet-Dañon D, Guitard J, Grenouillet F, Gay F, Ait-Ammar N, Angoulvant A, Marinach C, Hennequin C. Rapid diagnosis of cryptococcosis using an antigen detection immunochromatographic test. J Infect 2015; 70:499-503. [PMID: 25597824 DOI: 10.1016/j.jinf.2014.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/13/2014] [Accepted: 12/18/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Current methods for cryptococcal antigen detection have some limitations. This study aimed at evaluating a lateral flow assay (LFA) for the diagnosis of cryptococcosis in a French University medical center. METHODS A retrospective study was performed on samples collected from patients with a definitive diagnosis of cryptococcosis (group I 66 samples; 28 patients) or with non-Cryptococcus invasive fungal infection (group II 18 samples; 17 patients). In addition, 274 samples from 205 consecutive patients, either suspected of cryptococcal infection or routinely screened during their follow-up, were prospectively tested (group III). Cryptococcal antigen was assayed using LFA and an EIA. A latex-based test was used for confirmation. RESULTS Sensitivity calculated on group I and specificity on group II, were respectively at 100% and 90.0%. Two false positives were related to Trichosporon fungemia. Per-sample analysis on group III revealed sensitivity, specificity, positive and negative predictive values all at 100% for CSF, and at 100%, 98.9%, 75% and 100%, respectively for serum samples. LFA enabled the diagnosis of two cases of asymptomatic cryptococcosis. CONCLUSION The excellent diagnostic value and practicality (visual reading results in 15 min) of LFA make it fully appropriate for the diagnosis of cryptococcosis in this particular setting.
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Affiliation(s)
- Diane Rivet-Dañon
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Service de Parasitologie-Mycologie, F-75012, Paris, France
| | - Juliette Guitard
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Service de Parasitologie-Mycologie, F-75012, Paris, France; Inserm, U1135, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; CNRS, ERL 8255, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'hôpital, F-75013, Paris, France
| | - Frédéric Grenouillet
- Centre Hospitalier Régional Universitaire de Besançon, Service de Parasitologie-Mycologie, F-25030, Besançon, France
| | - Frédérick Gay
- Inserm, U1135, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; CNRS, ERL 8255, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'hôpital, F-75013, Paris, France; Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Parasitologie-Mycologie, F-75013, Paris, France
| | - Nawel Ait-Ammar
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Service de Microbiologie, F-92100, Boulogne-Billancourt, France
| | - Adela Angoulvant
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Microbiologie, F-94270, Le Kremlin-Bicêtre, France
| | - Carine Marinach
- Inserm, U1135, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; CNRS, ERL 8255, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'hôpital, F-75013, Paris, France
| | - Christophe Hennequin
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Service de Parasitologie-Mycologie, F-75012, Paris, France; Inserm, U1135, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; CNRS, ERL 8255, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'hôpital, F-75013, Paris, France.
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Abstract
Despite increasing availability of anti-retroviral therapy, invasive cryptococcal disease continues to be a leading cause of death among HIV-infected individuals in resource-limited settings. Screening asymptomatic HIV-infected individuals with advanced immunosuppression for serum cryptococcal antigen clearly identifies a population at high risk of cryptococcal meningitis and death. However, screening with serum cryptococcal antigen alone identifies a heterogeneous clinical population, many of whom have mild clinical symptoms, sub-clinical meningeal infection, or fungemia. Currently, there is wide variation in practice and little evidence to guide the use of anti-fungal and anti-retroviral treatment for asymptomatic cryptococcal antigenemia (ACA). Furthermore, implementing a targeted screening and treatment intervention for ACA presents numerous operational challenges for already overburdened health care systems in resource-limited settings. While such an intervention shows promise, there are critical gaps in our understanding of ACA and its implications in the outpatient setting and an urgent need for additional research in this area.
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Zhou Q, Hu B, Shao C, Zhou C, Zhang X, Yang D, Li C. A case report of pulmonary cryptococcosis presenting as endobronchial obstruction. J Thorac Dis 2013; 5:E170-3. [PMID: 23991332 DOI: 10.3978/j.issn.2072-1439.2013.08.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 08/16/2013] [Indexed: 12/15/2022]
Abstract
Cryptococcosis presenting as endobronchial obstruction was scarce. We report a case of patient with cryptococcosis. A chest CT scan showed masses in the right upper lobe and right hilar, with evidence of narrowing of the right upper lobe bronchus. PET-CT scans showed the mass in the bronchus with the high mSUVs. A biopsy specimen was taken from the mass by lung puncture biopsy and showed cryptococcus infection. Culture of lung tissue was C. neoformans. The serum was positive for cryptococcal antigen, with a titer of more than 1(:)1,280. He was successfully treated using amphotericin B liposome. This case is worth discussing because it was cryptococcosis presenting as endobronchial obstruction that is often considered tumor.
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Affiliation(s)
- Qing Zhou
- Department of Infection Control, Zhongshan Hospital Fudan University, Shanghai, China
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New Insights into HIV/AIDS-Associated Cryptococcosis. ISRN AIDS 2013; 2013:471363. [PMID: 24052889 PMCID: PMC3767198 DOI: 10.1155/2013/471363] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/10/2013] [Indexed: 12/27/2022]
Abstract
Cryptococcal meningitis is a life-threatening opportunistic fungal infection in both HIV-infected and HIV-uninfected patients. According to the most recent taxonomy, the responsible fungus is classified into a complex that contains two species (Cryptococcus neoformans and C. gattii), with eight major molecular types. HIV infection is recognized worldwide as the main underlying disease responsible for the development of cryptococcal meningitis (accounting for 80-90% of cases). In several areas of sub-Saharan Africa with the highest HIV prevalence despite the recent expansion of antiretroviral (ARV) therapy programme, cryptococcal meningitis is the leading cause of community-acquired meningitis with a high mortality burden. Although cryptococcal meningitis should be considered a neglected disease, a large body of knowledge has been developed by several studies performed in recent years. This paper will focus especially on new clinical aspects such as immune reconstitution inflammatory syndrome, advances on management, and strategies for the prevention of clinical disease.
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