Cryptococcosis in HIV-infected hospitalized patients in Germany: Evidence for routine antigen testing
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Cryptococcosis in HIV-infected hospitalized patients in Germany: Evidence for routine antigen testing. / Katchanov, Juri; Jefferys, Laura; Tominski, Daniela; Wöstmann, Kai; Slevogt, Hortense; Arastéh, Keikawus; Stocker, Hartmut.
in: J INFECTION, Jahrgang 71, Nr. 1, 07.2015, S. 110-6.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Cryptococcosis in HIV-infected hospitalized patients in Germany: Evidence for routine antigen testing
AU - Katchanov, Juri
AU - Jefferys, Laura
AU - Tominski, Daniela
AU - Wöstmann, Kai
AU - Slevogt, Hortense
AU - Arastéh, Keikawus
AU - Stocker, Hartmut
N1 - Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
PY - 2015/7
Y1 - 2015/7
N2 - 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.
AB - 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.
U2 - 10.1016/j.jinf.2015.01.011
DO - 10.1016/j.jinf.2015.01.011
M3 - SCORING: Journal article
C2 - 25644318
VL - 71
SP - 110
EP - 116
JO - J INFECTION
JF - J INFECTION
SN - 0163-4453
IS - 1
ER -
