Cryptococcosis in HIV-infected hospitalized patients in Germany: Evidence for routine antigen testing. Issue 1 (July 2015)

• Record Type: Journal Article
• Authors: Katchanov, Juri; Jefferys, Laura; Tominski, Daniela; Wöstmann, Kai; Slevogt, Hortense; Arastéh, Keikawus; Stocker, Hartmut
• Is Part Of: Journal of infection. Volume 71:Issue 1(2015)
• Page Start: 110
• Page End: 116
• Publication Date: 2015-07
• Subjects: Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2015.01.011
• Languages: English
• ISSNs: 0163-4453

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Summary</title> <sec> <title id="sectitle0015">Objectives</title> <p id="abspara0010">To investigate the diagnostic value of routine cryptococcal antigen (CRAG) testing in HIV-infected patients in a low prevalence setting.</p> </sec> <sec> <title id="sectitle0020">Methods</title> <p id="abspara0015">Retrospective single centre cohort study of a 10-year period (2005–2014).</p> </sec> <sec> <title id="sectitle0025">Results</title> <p id="abspara0020">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.</p> </sec> <sec> <title id="sectitle0030">Conclusion</title> <p id="abspara0025">Our data support routine CRAG testing in hospitalized HIV-infected patients with CD4 counts ≤200/μl, and/or pneumocystis pneumonia.</p> </sec> </abstract>