ABSTRACT
Introduction: Cryptococcal meningitis is one of the leadingopportunistic infections associated with high mortality. Thepresent study was carried out to determine the prevalence ofcryptococcal antigenemia in HIV-infected patients with CD4+T-cell count ≤ 200 cells/μl.Material and methods: A cross-sectional study includinga total of 100 blood samples of HIV-infected patients withCD4+ T-cell count ≤ 200 cells/μl was carried out in a tertiarycare hospital. The Cryptococcal Antigen Latex AgglutinationTest was performed on serum separated from blood samplesincluded in the study group. A positive cryptococcalantigenemia was diagnosed by positive latex agglutinationtest of cryptococcal polysaccharide antigen in serum. BMI ofall patients included in the study group was calculated andWHO clinical staging of all patients was noted.Results: Three cases out of 100 were positive for cryptococcalantigenemia. The positive cases showed correlation with lowBMI and WHO Clinical stage II and III of HIV disease. Inthe present study, 33.33% and 66.67% of positive cases hadCD4+ T-cell count within the range of 0-100cells/μl and101-200cells/μl respectively.Conclusion: It is important to implement routine screeningfor cryptococcal antigen among HIV-infected cases withCD4+ T-cell count ≤ 200 cells/μl for early detection ofcryptococcal antigenemia. It will help in identifying the riskof subsequent cryptococcal meningitis and initiation of preemptive antifungal treatment.
ABSTRACT
Objective To evaluate the prevalence of cryptococcal antigenemia and explore the related cryptococcal lesions in hospitalized human immunodeficiency virus ( HIV )-infected patients . Methods Medical records of 517 HIV-infected patients ,including patients'age ,sex ,clinical features , previous medical history ,laboratory tests ,chest CT ,treatment and the response to treatment ,in the Second Hospital of the Nanjing between January 2016 and February 2018 were retrospectively analyzed . The serum cryptococcal antigen (sCrAg) was detected by lateral flow immunoassay .The χ2 test or Fisherexact test was used to perform the statistical analysis .Results Among 517 HIV-infected cases ,51 were sCrAg positive ,of whom 96 .1％ (49 cases) were men .The cases with CD4+ T lymphocyte count <100 × 106 cells/L accounted for 66 .2％ (342 cases) ,while 90 .2％ (46 cases) in sCrAg-positive patients showed CD4+ T lymphocyte count < 100 × 106 cells/L with statistical significance (χ2 = 14 .6 , P< 0 .01 ) . Multivariable analysis revealed that CD4+ T lymphocyte count <100 × 106 cells/L was independent risk factor for cryptococcal antigenemia (OR= 4 .7;95％ CI:1 .8 -12 .5 , P< 0 .01) .Clinical cryptococcal diseases were found in 76 .4％ (39/51 ) of patients with cryptococcal antigenemia , and cryptococcal meningitis (CM) ,pulmonary cyptococcosis (PC) and cryptococcal septicemia were found in 56％ (28/50) ,52 .9％ (27/51) and 44 .4％ (16/36) of the patients ,respectively .Cryptoccal disease was not identified in 21 .6％ (11/51 ) of the patients with cryptococcal antigenemia (isolated cryptococcal antigenemia) .The median (range) sCrAg titers of the patients with and without CM were 1:1280 (1:10-1:2560) and 1 :15 (1:2-1:2560) ,respectively (P<0 .01) .The proportion of CM in patients with sCrAg titers ≤1:5 ,1:10 -1:320 and ≥1:640 were 0 (0/10) ,50％ (10/20) and 90％ (18/20) , respectively .When cryptococcal infection was restricted to the lung ,87 .5％ (7/8) of the patients had sCrAg titers ≤1:20 .30％ (3/10) of the patients with sCrAg titers ≤1:5 had PC .The median (range) sCrAg titers of the patients with cryptococcal septicemia and with isolated cryptococcal antigenemia were 1:1280 (1:10 -1:2560 ) and 1:5 (1:2 -1:320 ) , respectively . Conclusions T he prevalence of cryptococcal antigenmia is high in hospitalized HIV-infected patients . Most patients with cryptococcal antigenemia have developed cryptococcal diseases .The sCrAg titer in HIV patients may ,in some extend , predicts the condition of cryptococcal infection .sCrAg titers ≥ 1:640 are strongly suggestive of CM . Patients with sCrAg titers ≤1:5 seems unlikely to have CM or cryptococcal septicemia ,however ,clinician should still be alarmed of possible PC .