Cryptococcosis in HIV-infected hospitalized patients in Germany: Evidence for routine antigen testing - 04/06/15
, Laura Jefferys a, Daniela Tominski a, Kai Wöstmann a, Hortense Slevogt b, Keikawus Arastéh a, Hartmut Stocker aSummary |
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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Cryptococcal antigenaemia was found in 1.6% of patients with CD4 counts of ≤100/μl. |
• | Prevalence of cryptococcal antigenaemia was highest in pneumocystis pneumonia. |
• | 10% of patients with disseminated cryptococcosis had CRAG titres <1:16. |
• | PPV for identifying clinically relevant cryptococcal disease was >95%. |
• | Recommend CRAG testing in HIV with CD4 ≤200/μl admitted to inpatient care. |
Keywords : Cryptococcal antigenaemia, Cryptococcosis, HIV, AIDS
Plan
Vol 71 - N° 1
P. 110-116 - juillet 2015 Retour au numéro
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