Médecins Sans Frontières, Maputo, Mozambique.
Division of Infectious Diseases, Department of Medicine, University of California, San Diego, California, United States of America.
PLoS One. 2021 Apr 26;16(4):e0250195. doi: 10.1371/journal.pone.0250195. eCollection 2021.
Cryptococcal meningitis is a leading cause of HIV-related mortality in sub-Saharan Africa, however, screening for cryptococcal antigenemia has not been universally implemented. As a result, data concerning cryptococcal meningitis and antigenemia are sparse, and in Mozambique, the prevalence of both are unknown.
We performed a retrospective analysis of routinely collected data from a point-of-care cryptococcal antigen screening program at a public hospital in Maputo, Mozambique. HIV-positive patients admitted to the emergency department underwent CD4 count testing; those with pre-defined abnormal vital signs or CD4 count ≤ 200 cells/μL received cryptococcal antigen testing and lumbar punctures if indicated. Patients with CM were admitted to the hospital and treated with liposomal amphotericin B and flucytosine; their 12-week outcomes were ascertained through review of medical records or telephone contact by program staff made in the routine course of service delivery.
Among 1,795 patients screened for cryptococcal antigenemia between March 2018-March 2019, 134 (7.5%) were positive. Of patients with cryptococcal antigenemia, 96 (71.6%) were diagnosed with CM, representing 5.4% of all screened patients. Treatment outcomes were available for 87 CM patients: 24 patients (27.6%) died during induction treatment and 63 (72.4%) survived until discharge; of these, 38 (60.3%) remained in care, 9 (14.3%) died, and 16 (25.3%) were lost-to follow-up at 12 weeks.
We found a high prevalence of cryptococcal antigenemia and meningitis among patients screened at an emergency department in Maputo, Mozambique. High mortality during and after induction therapy demonstrate missed opportunities for earlier detection of cryptococcal antigenemia, even as point-of-care screening and rapid assessment in an emergency room offer potential to improve outcomes.
隐球菌性脑膜炎是撒哈拉以南非洲地区与 HIV 相关死亡的主要原因，但隐球菌抗原血症的筛查并未普遍实施。因此，有关隐球菌性脑膜炎和抗原血症的数据很少，在莫桑比克，这两种疾病的患病率都不清楚。
我们对莫桑比克马普托一家公立医院的即时护理隐球菌抗原筛查计划中常规收集的数据进行了回顾性分析。急诊科收治的 HIV 阳性患者进行 CD4 计数检测；那些具有明确异常生命体征或 CD4 计数≤200 个/μL 的患者接受隐球菌抗原检测，如果需要则进行腰椎穿刺。患有隐球菌性脑膜炎的患者入院接受两性霉素 B 脂质体和氟胞嘧啶治疗；通过服务提供过程中的常规程序，由项目工作人员对医疗记录进行审查或通过电话联系来确定 12 周的结果。
在 2018 年 3 月至 2019 年 3 月期间，对 1795 名接受隐球菌抗原血症筛查的患者中，有 134 名（7.5%）呈阳性。在患有隐球菌抗原血症的患者中，有 96 名（71.6%）被诊断为隐球菌性脑膜炎，占所有筛查患者的 5.4%。87 名隐球菌性脑膜炎患者的治疗结果可用：24 名患者（27.6%）在诱导治疗期间死亡，63 名（72.4%）存活至出院；其中，38 名（60.3%）继续接受治疗，9 名（14.3%）死亡，16 名（25.3%）在 12 周时失访。
我们发现，在莫桑比克马普托的急诊科筛查的患者中，隐球菌抗原血症和脑膜炎的患病率很高。诱导治疗期间和之后的高死亡率表明，即使在急诊室进行即时护理筛查和快速评估也有可能改善结果，但仍存在隐球菌抗原血症早期检测的机会错失。
