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Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program

Cryptococcal disease is an important opportunistic infection among people living with HIV. The cryptococcal antigen (CrAg) can be detected before the clinical onset of meningitis and its screening is recommended. Here, we evaluated CrAg frequency, and describe the epidemiological characteristics and...

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Autores principales: Medina, Narda, Rodriguez-Tudela, Juan Luis, Pérez, Juan Carlos, Mercado, Danicela, Bonilla, Oscar, Arathoon, Eduardo, Alastruey-Izquierdo, Ana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9323764/
https://www.ncbi.nlm.nih.gov/pubmed/35889106
http://dx.doi.org/10.3390/microorganisms10071388
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author Medina, Narda
Rodriguez-Tudela, Juan Luis
Pérez, Juan Carlos
Mercado, Danicela
Bonilla, Oscar
Arathoon, Eduardo
Alastruey-Izquierdo, Ana
author_facet Medina, Narda
Rodriguez-Tudela, Juan Luis
Pérez, Juan Carlos
Mercado, Danicela
Bonilla, Oscar
Arathoon, Eduardo
Alastruey-Izquierdo, Ana
author_sort Medina, Narda
collection PubMed
description Cryptococcal disease is an important opportunistic infection among people living with HIV. The cryptococcal antigen (CrAg) can be detected before the clinical onset of meningitis and its screening is recommended. Here, we evaluated CrAg frequency, and describe the epidemiological characteristics and mortality at 180 days in a cohort of HIV patients from Guatemala. A total of 3457 patients were screened with a CrAg lateral flow assay in serum between January 2017 and December 2018. CrAg positivity was 11.5% in patients with ≤100 CD4/mm(3), 8.7% in patients with <200 CD4/mm(3), and 6.3% in patients with <350 CD4/mm(3). In Latin America, we estimated 9.2% CrAg positivity (IC95% 7.9–10.7%) in patients with ≤100 CD4/mm(3). Among patients newly diagnosed with HIV, we estimated 4416 incident cases per year in Latin America in those with <200 CD4/mm(3) and 5289 in those with <350 CD4/mm(3). In addition, we calculated the burden in people not on ARV or without viral suppression and found 28,672 cases. CrAg screening should be considered in patients who have a CD4 cell count < 350 cells/mm(3). Cryptococcal meningitis was associated with 30.8% mortality in Guatemala. Global access to diagnosis as well as to liposomal amphotericin B and flucytosine is a priority.
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spelling pubmed-93237642022-07-27 Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program Medina, Narda Rodriguez-Tudela, Juan Luis Pérez, Juan Carlos Mercado, Danicela Bonilla, Oscar Arathoon, Eduardo Alastruey-Izquierdo, Ana Microorganisms Article Cryptococcal disease is an important opportunistic infection among people living with HIV. The cryptococcal antigen (CrAg) can be detected before the clinical onset of meningitis and its screening is recommended. Here, we evaluated CrAg frequency, and describe the epidemiological characteristics and mortality at 180 days in a cohort of HIV patients from Guatemala. A total of 3457 patients were screened with a CrAg lateral flow assay in serum between January 2017 and December 2018. CrAg positivity was 11.5% in patients with ≤100 CD4/mm(3), 8.7% in patients with <200 CD4/mm(3), and 6.3% in patients with <350 CD4/mm(3). In Latin America, we estimated 9.2% CrAg positivity (IC95% 7.9–10.7%) in patients with ≤100 CD4/mm(3). Among patients newly diagnosed with HIV, we estimated 4416 incident cases per year in Latin America in those with <200 CD4/mm(3) and 5289 in those with <350 CD4/mm(3). In addition, we calculated the burden in people not on ARV or without viral suppression and found 28,672 cases. CrAg screening should be considered in patients who have a CD4 cell count < 350 cells/mm(3). Cryptococcal meningitis was associated with 30.8% mortality in Guatemala. Global access to diagnosis as well as to liposomal amphotericin B and flucytosine is a priority. MDPI 2022-07-10 /pmc/articles/PMC9323764/ /pubmed/35889106 http://dx.doi.org/10.3390/microorganisms10071388 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Medina, Narda
Rodriguez-Tudela, Juan Luis
Pérez, Juan Carlos
Mercado, Danicela
Bonilla, Oscar
Arathoon, Eduardo
Alastruey-Izquierdo, Ana
Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program
title Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program
title_full Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program
title_fullStr Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program
title_full_unstemmed Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program
title_short Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program
title_sort epidemiology and mortality of cryptococcal disease in guatemala: two-year results of a cryptococcal antigen screening program
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9323764/
https://www.ncbi.nlm.nih.gov/pubmed/35889106
http://dx.doi.org/10.3390/microorganisms10071388
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