Silva Adriana Paulino, Zenatti Carolina Toniolo, Figueiredo-Mello Claudia, Negra Marinella Della, Levin Anna S, Boulware David R, Vidal José Ernesto
Deparment of Infectious Diseases, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
Department of Infectious Diseases, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Int J STD AIDS. 2020 Mar;31(4):345-350. doi: 10.1177/0956462419847161. Epub 2020 Feb 23.
Community-acquired pneumonia (CAP) is a common cause of hospitalization among people living with HIV/AIDS (PLWHA), particularly those with severe immunosuppression. Pulmonary disease due to cryptococcosis is uncommonly reported and likely under-diagnosed. There is scarce information cryptococcal antigen (CrAg) prevalence in PLWHA with CAP. The objectives of this study were to identify among PLWHA who were hospitalized with CAP: i) the prevalence of serum CrAg positivity, ii) the proportion with asymptomatic vs. symptomatic cryptococcosis; and iii) the prevalence of serum CrAg positivity in CD4+ T-cell count <100 cells/mm. We performed a sub-analysis of a prospective cohort of hospitalized adults enrolled into randomized clinical trial testing therapy for CAP. We included 202 participants who had a serum CrAg testing performed. We found a 3.5% prevalence of serum CrAg-positivity overall, being higher (4.8%) in CD4+ T-cell count <100 cells/mm. Asymptomatic and symptomatic cryptococcosis was present in 2.0% and 1.5% overall, respectively. This study identifies a target population for CrAg testing: PLWHA hospitalized with diagnosis of CAP, particularly those with CD4+ T-cell count <100 cells/mm where the number needed to test was 18 to detect 1 CrAg-positive person. This approach may facilitate the detection of asymptomatic cryptococcal infection and allow a timely diagnosis of symptomatic cryptococcal disease.
社区获得性肺炎（CAP）是人类免疫缺陷病毒/艾滋病（PLWHA）感染者住院治疗的常见原因，尤其是那些免疫抑制严重的患者。隐球菌病导致的肺部疾病报道较少，可能诊断不足。关于合并CAP的PLWHA中隐球菌抗原（CrAg）流行情况的信息匮乏。本研究的目的是在因CAP住院的PLWHA中确定：i）血清CrAg阳性的患病率；ii）无症状与有症状隐球菌病的比例；以及iii）CD4+T细胞计数<100个细胞/mm³时血清CrAg阳性的患病率。我们对纳入CAP治疗随机临床试验的住院成人前瞻性队列进行了亚分析。我们纳入了202名进行血清CrAg检测的参与者。我们发现总体血清CrAg阳性患病率为3.5%，在CD4+T细胞计数<100个细胞/mm³的患者中更高（4.8%）。无症状和有症状隐球菌病的总体患病率分别为2.0%和1.5%。本研究确定了CrAg检测的目标人群：因CAP诊断住院的PLWHA，尤其是那些CD4+T细胞计数<100个细胞/mm³的患者，检测18人才能发现1例CrAg阳性者。这种方法可能有助于检测无症状隐球菌感染，并能及时诊断有症状隐球菌病。
