High Cryptococcal Antigen Titers in Blood Are Predictive of Subclinical Cryptococcal Meningitis Among Human Immunodeficiency Virus-Infected Patients

High mortality rates among asymptomatic cryptococcal antigen (CrAg)-positive patients identified through CrAg screening, despite preemptive fluconazole treatment, may be due to undiagnosed cryptococcal meningitis. Symptoms were reviewed in CrAg-positive patients identified by screening 19233 individ...

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Bibliographic Details
Published in:Clinical infectious diseases 2018-03, Vol.66 (5), p.686-692
Main Authors: Wake, Rachel M, Britz, Erika, Sriruttan, Charlotte, Rukasha, Ivy, Omar, Tanvier, Spencer, David C, Nel, Jeremy S, Mashamaite, Sello, Adelekan, Adeboye, Chiller, Tom M, Jarvis, Joseph N, Harrison, Thomas S, Govender, Nelesh P
Format: Article
Language:English
Subjects:
and Commentaries
Blood
CD4 antigen
Cell culture
Cerebrospinal fluid
Confidence intervals
Fluconazole
Fungicides
Headache
Health risks
HIV
Hospitals
Human immunodeficiency virus
Meningitis
Microscopy
Mortality
Patients
Preempting
Screening
Viruses
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Summary:High mortality rates among asymptomatic cryptococcal antigen (CrAg)-positive patients identified through CrAg screening, despite preemptive fluconazole treatment, may be due to undiagnosed cryptococcal meningitis. Symptoms were reviewed in CrAg-positive patients identified by screening 19233 individuals with human immunodeficiency virus infection and CD4 cell counts 160 (sensitivity, 88.2%; specificity, 82.1%); the odds ratio for concurrent cryptococcal meningitis was 34.5 (95% confidence interval, 8.3-143.1; P < .001). About a third of asymptomatic CrAg-positive patients have concurrent cryptococcal meningitis. More effective clinical assessment strategies and antifungal regimens are required for CrAg-positive patients, including investigation for cryptococcal meningitis irrespective of symptoms. Where it is not possible to perform lumbar punctures in all CrAg-positive patients, blood CrAg titers should be used to target those most at risk of cryptococcal meningitis.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/cix872