Oliveira Fernanda Gurgel, Nakagawa Jeanne Aiko de Souza, de Oliveira Jefersson Matheus Maia, Júnior Rodovaldo Moraes Lucas, Marcusso Rosa, Vidal José E
Departamento de Infectologia, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
Departamento de Neurologia, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
Med Mycol. 2023 Sep 4;61(9). doi: 10.1093/mmy/myad093.
Timely diagnosis is key in managing central nervous system (CNS) cryptococcosis in people living with HIV/AIDS (PLWHA). There are few data on implementing fingerprick whole-blood cryptococcal antigen (CrAg) lateral flow assay (LFA) as the first test for diagnosing CNS cryptococcosis. We evaluated the prevalence of CNS cryptococcosis and cryptococcal antigenemia using fingerprick whole-blood in a referral emergency department (ED) in São Paulo, Brazil. This was a prospective cohort study of consecutive adult PLWHA with advanced HIV disease and neurological symptoms. Fingerprick whole-blood CrAg LFA was performed at bedside. Seventy-four individuals were enrolled (median age = 40 years; males = 62%). Prevalence of CNS cryptococcosis was 17.6% (13/74); 95% confidence interval (CI), 9.4-30.0%, and prevalence of positive fingerprick whole-blood CrAg LFA was 25.7% (19/74); 95% CI, 15.5-40.1%. Among the six (8.1%) patients with positive fingerprick whole-blood CrAg LFA and negative CSF CrAg LFA, four (5.4%) had isolated asymptomatic cryptococcal antigenemia, one (1.3%) had symptomatic cryptococcal antigenemia, and one (1.3%) had cryptococcemia. Prevalence of CNS cryptococcosis and cryptococcal antigenemia using fingerprick whole-blood CrAg LFA was high. Point-of-care testing was important for diagnosing CNS cryptococcosis in an ED from a middle-income country.
及时诊断是管理艾滋病毒/艾滋病（PLWHA）患者中枢神经系统（CNS）隐球菌病的关键。关于采用指尖全血隐球菌抗原（CrAg）侧向流动分析法（LFA）作为诊断中枢神经系统隐球菌病的首选检测方法的数据很少。我们在巴西圣保罗的一家转诊急诊科（ED）评估了使用指尖全血检测中枢神经系统隐球菌病和隐球菌血症的患病率。这是一项针对患有晚期HIV疾病和神经系统症状的成年PLWHA的前瞻性队列研究。在床边进行指尖全血CrAg LFA检测。共纳入74人（中位年龄 = 40岁；男性 = 62%）。中枢神经系统隐球菌病的患病率为17.6%（13/74）；95%置信区间（CI）为9.4 - 30.0%，指尖全血CrAg LFA检测呈阳性的患病率为25.7%（19/74）；95% CI为15.5 - 40.1%。在指尖全血CrAg LFA检测呈阳性而脑脊液CrAg LFA检测呈阴性的6名（8.1%）患者中，4名（5.4%）有孤立的无症状隐球菌血症，1名（1.3%）有症状性隐球菌血症，1名（1.3%）有隐球菌血症。使用指尖全血CrAg LFA检测中枢神经系统隐球菌病和隐球菌血症的患病率很高。即时检测对于在中等收入国家的急诊科诊断中枢神经系统隐球菌病很重要。
