Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey.
Department of Infectious Diseases, Faculty of Medicine, University of Çukurova, Adana, Turkey.
Mycoses. 2019 Oct;62(10):961-968. doi: 10.1111/myc.12969. Epub 2019 Aug 18.
Cryptococcus neoformans causes life-threatening meningoencephalitis, particularly in human immunodeficiency virus (HIV)-positive individuals with low CD4 levels (<100 cells/μL). Although the burden of cryptococcal meningoencephalitis (CM) in Turkey is low (0.13 cases per 100 000 persons), asymptomatic individuals at risk of cryptococcosis should be screened for antigenemia to prevent the disease and/or promote early CM diagnosis. A lateral flow assay (LFA) is used to detect Cryptococcus antigen (CrAg) in cerebrospinal fluid and serum. We determined Cryptococcus antigenemia prevalence in serum samples of HIV-positive and HIV-negative adult patients by using Dynamiker® CrAg-LFA, a point-of-care dipstick test. Patients' demographic data, CD4 count, HIV-RNA levels and anti-retroviral therapy status were recorded. CrAg was detected in 28 (11%) of 254 HIV-positive patients screened but not in 100 HIV-negative control individuals; a significant difference was observed in the CrAg-LFA positivity rate between HIV-positive and HIV-negative groups (x = 11.970; P < .05). In CrAg-positive patients, the median CD4 level was 666 cells/μL (115-1344 cells/μL), with a median viral load of 23 copies/mL (0-3.69 × 10 copies/mL). In HIV-positive CrAg-negative patients, the median CD4 level was 633 cells/μL (31-2953 cells/μL) and the median viral load was 12 copies/mL (0-1.95 × 10 copies/mL; P > .05). Results indicate that HIV-positive patients with both low (<200 cells/μL) and high (>200 cells/μL) CD4 counts should be screened for asymptomatic cryptococcal antigenemia. HIV-associated asymptomatic cryptococcosis is not uncommon in Turkey, which warrants systematic screening. Updated strategies for CM prevention among HIV-positive patients should be used even in non-endemic countries.
新型隐球菌引起危及生命的脑膜脑炎，特别是在人类免疫缺陷病毒（HIV）阳性且 CD4 水平较低（<100 个细胞/μL）的个体中。尽管土耳其的隐球菌脑膜脑炎（CM）负担较低（每 100000 人中有 0.13 例），但应筛查有隐球菌病风险的无症状个体，以预防该病和/或促进早期 CM 诊断。侧向流动分析（LFA）用于检测脑脊液和血清中的隐球菌抗原（CrAg）。我们使用 Dynamerker® CrAg-LFA，一种即时检测的点刺试验，来确定 HIV 阳性和 HIV 阴性成年患者的血清样本中隐球菌抗原血症的患病率。记录了患者的人口统计学数据、CD4 计数、HIV-RNA 水平和抗逆转录病毒治疗状况。在筛查的 254 名 HIV 阳性患者中，有 28 名（11%）检测到 CrAg，但在 100 名 HIV 阴性对照个体中未检测到；HIV 阳性组和 HIV 阴性组的 CrAg-LFA 阳性率存在显著差异（x ²=11.970；P<.05）。在 CrAg 阳性患者中，中位数 CD4 水平为 666 个细胞/μL（115-1344 个细胞/μL），中位数病毒载量为 23 拷贝/mL（0-3.69×10 拷贝/mL）。在 HIV 阳性 CrAg 阴性患者中，中位数 CD4 水平为 633 个细胞/μL（31-2953 个细胞/μL），中位数病毒载量为 12 拷贝/mL（0-1.95×10 拷贝/mL；P>.05）。结果表明，CD4 计数较低（<200 个细胞/μL）和较高（>200 个细胞/μL）的 HIV 阳性患者均应筛查无症状隐球菌抗原血症。土耳其 HIV 相关无症状隐球菌病并不少见，需要进行系统筛查。即使在非流行地区，也应使用针对 HIV 阳性患者的 CM 预防更新策略。
