Micol Romain, Lortholary Olivier, Sar Borann, Laureillard Didier, Ngeth ChanChhaya, Dousset Jean-Philippe, Chanroeun Hak, Ferradini Laurent, Guerin Philippe Jean, Dromer Françoise, Fontanet Arnaud
Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France.
J Acquir Immune Defic Syndr. 2007 Aug 15;45(5):555-9. doi: 10.1097/QAI.0b013e31811ed32c.
To determine the prevalence, determinants ofpositivity, and clinical utility of serum cryptococcal polysaccharide (CPS) antigen testing among HIV-infected patients in 2004 in Cambodia, an area highly endemic for cryptococcosis.
All HIV-infected patients with a CD4+ count <200 cells/mm3 attending 1 of 2 Phnom Penh hospitals for the first time were systematically screened for serum CPS. Patients with positive test results were further investigated to identify those with cryptococcal meningitis (CM), pulmonary cryptococcosis, or isolated positive cryptococcal antigenemia (IPCA).
The median (interquartile range [IQR]) CD4+ count of 327 enrolled patients was 24 (IQR: 8 to 65) cells/mm3. The prevalence of cryptococcal infection was 59 (18.0%) of 327 cases, of which 41 were CM and 10 were IPCA. In the absence of serum CPS detection, 17 (28.8%) of 59 cryptococcal infections would have been missed on the day of consultation. In patients with no specific symptoms of meningoencephalitis, the prevalence of positive serum CPS detection was 32 (10.8%) of 295 cases. Countryside residence (adjusted odds ratio [AOR] = 3.6), headache (AOR = 3.2), body mass index <15.4 kg/m2 (AOR = 3.4), CD4+ count <50 cells/mm3 (AOR = 4.0), and male gender (marginally, AOR = 2.1) were all independently associated with a positive test results.
Serum CPS screening among AIDS patients with a CD4+ count <100 cells/mm3 is useful in areas highly endemic for cryptococcosis, allowing early diagnosis and treatment of this opportunistic infection.
确定2004年柬埔寨艾滋病病毒（HIV）感染者中血清隐球菌多糖（CPS）抗原检测的患病率、阳性决定因素及临床应用价值，柬埔寨是隐球菌病的高流行地区。
首次到金边两家医院之一就诊的所有CD4+细胞计数<200个/mm³的HIV感染者均接受血清CPS系统筛查。检测结果呈阳性的患者进一步接受检查，以确定患有隐球菌性脑膜炎（CM）、肺隐球菌病或孤立性阳性隐球菌血症（IPCA）的患者。
327名入组患者的CD4+细胞计数中位数（四分位间距[IQR]）为24（IQR：8至65）个/mm³。327例患者中隐球菌感染患病率为59例（18.0%），其中41例为CM，10例为IPCA。若未进行血清CPS检测，59例隐球菌感染中有17例（28.8%）在就诊当日会被漏诊。在无脑膜脑炎特异性症状的患者中，295例患者血清CPS检测阳性率为32例（10.8%）。农村居住（校正比值比[AOR]=3.6）、头痛（AOR=3.2）、体重指数<15.4kg/m²（AOR=3.4）、CD4+细胞计数<50个/mm³（AOR=4.0）以及男性（临界值，AOR=2.1）均与检测结果呈阳性独立相关。
在隐球菌病高流行地区，对CD4+细胞计数<100个/mm³的艾滋病患者进行血清CPS筛查有助于早期诊断和治疗这种机会性感染。
