Document Detail


Prevalence and outcomes of cryptococcal antigenemia in HIV-seropositive patients hospitalized for suspected tuberculosis in Uganda.
MedLine Citation:
PMID:  23542636     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cryptococcal infection occurs in HIV-seropositive patients and is associated with high mortality. However, limited information is available on the prevalence and outcomes of cryptococcal antigenemia among hospitalized HIV-seropositive patients in sub-Saharan Africa.
OBJECTIVES: To determine the prevalence of and risk factors for cryptococcal antigenemia among HIV-seropositive patients presenting to Mulago Hospital (Kampala, Uganda) with unexplained cough ≥2 weeks and suspected tuberculosis (TB) and also to determine if antigenemia is associated with an increased mortality.
METHODS: Between September 2009 and September 2010, we enrolled consecutive HIV-seropositive adults hospitalized at Mulago Hospital with cough ≥2 weeks and suspected TB. Banked serum was tested for cryptococcal antigen. We compared demographic and clinical characteristics, and 2-month mortality in patients with and without cryptococcal antigenemia.
RESULTS: Of 563 HIV-seropositive patients, 32 (5.7%) were cryptococcal antigen (CrAg) positive. None had Cryptococcus neoformans detected on fungal culture of bronchoalveolar lavage fluid (n = 116). CrAg-positive patients had a lower median CD4 count compared with CrAg-negative patients (25 vs. 55 cells/μL, P = 0.02), and a substantial proportion of CrAg-positive patients also had concurrent TB (31%). A positive CrAg test was not associated with increased mortality during the 2-month follow-up period (hazard ratio: 0.99, 95% confidence interval: 0.63 to 1.54, P = 0.95) after adjusting for CD4 count and antiretroviral therapy use at enrollment and/or follow-up.
CONCLUSIONS: Occult cryptococcal antigenemia occurs commonly among hospitalized HIV-seropositive patients with suspected TB. CrAg testing should be considered in hospitalized HIV-seropositive patients with CD4 count <50 cells/μL, coupled with longer follow-up to evaluate the diagnostic value of CrAg and therapeutic interventions in patients with asymptomatic cryptococcal antigenemia.
Authors:
Alfred O Andama; Saskia den Boon; David Meya; Adithya Cattamanchi; William Worodria; J Lucian Davis; Nicholas D Walter; Samuel D Yoo; Nelson Kalema; Barbara Haller; Laurence Huang;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  63     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-13     Completed Date:  2013-07-08     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  189-94     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections / diagnosis,  epidemiology*
Adult
Antigens, Fungal / blood*
Cryptococcosis / complications,  diagnosis,  epidemiology*,  immunology
Cryptococcus / immunology,  isolation & purification
Female
HIV Infections / complications*
Humans
Male
Tuberculosis / complications*,  diagnosis
Uganda / epidemiology
Grant Support
ID/Acronym/Agency:
K23 AI080147/AI/NIAID NIH HHS; K23 HL094141/HL/NHLBI NIH HHS; K24 HL087713/HL/NHLBI NIH HHS; K24 HL087713/HL/NHLBI NIH HHS; R01 HL 090335/HL/NHLBI NIH HHS; R01 HL090335/HL/NHLBI NIH HHS; U01 AI089244/AI/NIAID NIH HHS; U01 AI089244-01/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Antigens, Fungal
Comments/Corrections

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