Meya David, Rajasingham Radha, Nalintya Elizabeth, Tenforde Mark, Jarvis Joseph N
Infectious Disease Institute, College of Health Sciences, Makerere University, Mulago Hill Road, # 22418, Kampala, Uganda ; Department of Medicine, Center for Infectious Diseases and Microbiology Translational Research, University of Minnesota, 450 Delaware Street, MMC250, Minneapolis, MN 55455 USA ; School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Medicine, Center for Infectious Diseases and Microbiology Translational Research, University of Minnesota, 450 Delaware Street, MMC250, Minneapolis, MN 55455 USA.
Curr Trop Med Rep. 2015;2(2):81-89. doi: 10.1007/s40475-015-0045-z.
Cryptococcosis remains a significant cause of morbidity and mortality among HIV-infected patients, especially in sub-Saharan Africa where it causes up to 20 % of AIDS-related deaths in HIV programs. A new, highly sensitive, and affordable point of care diagnostic test for cryptococcal infection, the lateral flow assay, can detect early sub-clinical cryptococcosis especially in areas with limited laboratory infrastructure. With a prevalence of detectable sub-clinical cryptococcal infection averaging 7.2 % (95 % CI 6.8-7.6 %) among 36 cohorts with CD4 <100 cells/μL in Africa, together with data showing that preemptive fluconazole prevents overt cryptococcal disease in this population, implementing a screen and treat strategy as part of HIV care practice among patients with CD4 <100 cells/μL could prevent the incidence of often fatal cryptococcal meningitis in the setting of the HIV pandemic.
隐球菌病仍然是艾滋病毒感染患者发病和死亡的重要原因，特别是在撒哈拉以南非洲地区，在那里它在艾滋病毒项目中导致高达20%的艾滋病相关死亡。一种用于隐球菌感染的新型、高灵敏度且经济实惠的即时诊断检测方法——侧向流动分析法，能够检测早期亚临床隐球菌病，尤其是在实验室基础设施有限的地区。在非洲36个CD4<100细胞/μL的队列中，可检测到的亚临床隐球菌感染患病率平均为7.2%（95%CI 6.8 - 7.6%），同时有数据表明，先发制性使用氟康唑可预防该人群发生显性隐球菌病，在CD4<100细胞/μL的患者中将筛查和治疗策略作为艾滋病毒护理实践的一部分，可在艾滋病毒大流行背景下预防通常致命的隐球菌性脑膜炎的发生。
