Outpatient Cryptococcal Antigen Screening Is Associated With Favorable Baseline Characteristics and Improved Survival in Persons With Cryptococcal Meningitis in Uganda
© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
BACKGROUND: It is unknown whether persons with symptomatic cryptococcal meningitis detected during routine blood cryptococcal antigen (CrAg) screening have better survival than persons presenting with overt meningitis.
METHODS: We prospectively enrolled Ugandans with HIV and cryptocococcal meningitis from December 2018 to December 2021. Participants were treated with amphotericin-based combination therapy. We compared outcomes between persons who were CrAg screened then referred to hospital with those presenting directly to the hospital with symptomatic meningitis.
RESULTS: Among 489 participants with cryptococcal meningitis, 40% (194/489) received blood CrAg screening and were referred to hospital (median time to referral 2 days; interquartile range [IQR], 1-6). CrAg-screened persons referred to hospital had lower 14-day mortality than non-CrAg-screened persons who presented directly to hospital with symptomatic meningitis (12% vs 21%; hazard ratio, .51; 95% confidence interval, .32-.83; P = .006). Fewer CrAg-screened participants had altered mental status versus non-CrAg-screened participants (29% vs 41%; P = .03). CrAg-screened persons had lower quantitative cerebrospinal fluid (CSF) culture burden (median [IQR], 4570 [11-100 000] vs 26 900 [182-324 000] CFU/mL; P = .01) and lower CSF opening pressures (median [IQR], 190 [120-270] vs 225 [140-340] mmH2O; P = .004) compared with non-CrAg-screened persons.
CONCLUSIONS: Survival from cryptococcal meningitis was higher in persons with prior CrAg screening than those without CrAg screening. Altered mental status was the most potent predictor for mortality in a multivariate model. We suggest that CrAg screening detects cryptococcal meningitis at an earlier stage, as evidenced by a favorable baseline risk profile and notably fewer persons with altered mental status.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:76 |
|---|---|
| Enthalten in: |
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America - 76(2023), 3 vom: 08. Feb., Seite e759-e765 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Levin, Anna E [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
AIDS |
|---|
| Anmerkungen: |
Date Completed 10.02.2023 Date Revised 27.02.2024 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.1093/cid/ciac599 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM343790998 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM343790998 | ||
| 003 | DE-627 | ||
| 005 | 20240229163305.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1093/cid/ciac599 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1308.xml |
| 035 | |a (DE-627)NLM343790998 | ||
| 035 | |a (NLM)35859045 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Levin, Anna E |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Outpatient Cryptococcal Antigen Screening Is Associated With Favorable Baseline Characteristics and Improved Survival in Persons With Cryptococcal Meningitis in Uganda |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 10.02.2023 | ||
| 500 | |a Date Revised 27.02.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: It is unknown whether persons with symptomatic cryptococcal meningitis detected during routine blood cryptococcal antigen (CrAg) screening have better survival than persons presenting with overt meningitis | ||
| 520 | |a METHODS: We prospectively enrolled Ugandans with HIV and cryptocococcal meningitis from December 2018 to December 2021. Participants were treated with amphotericin-based combination therapy. We compared outcomes between persons who were CrAg screened then referred to hospital with those presenting directly to the hospital with symptomatic meningitis | ||
| 520 | |a RESULTS: Among 489 participants with cryptococcal meningitis, 40% (194/489) received blood CrAg screening and were referred to hospital (median time to referral 2 days; interquartile range [IQR], 1-6). CrAg-screened persons referred to hospital had lower 14-day mortality than non-CrAg-screened persons who presented directly to hospital with symptomatic meningitis (12% vs 21%; hazard ratio, .51; 95% confidence interval, .32-.83; P = .006). Fewer CrAg-screened participants had altered mental status versus non-CrAg-screened participants (29% vs 41%; P = .03). CrAg-screened persons had lower quantitative cerebrospinal fluid (CSF) culture burden (median [IQR], 4570 [11-100 000] vs 26 900 [182-324 000] CFU/mL; P = .01) and lower CSF opening pressures (median [IQR], 190 [120-270] vs 225 [140-340] mmH2O; P = .004) compared with non-CrAg-screened persons | ||
| 520 | |a CONCLUSIONS: Survival from cryptococcal meningitis was higher in persons with prior CrAg screening than those without CrAg screening. Altered mental status was the most potent predictor for mortality in a multivariate model. We suggest that CrAg screening detects cryptococcal meningitis at an earlier stage, as evidenced by a favorable baseline risk profile and notably fewer persons with altered mental status | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a AIDS | |
| 650 | 4 | |a advanced HIV disease | |
| 650 | 4 | |a cryptococcal antigenemia | |
| 650 | 4 | |a cryptococcal meningitis | |
| 650 | 7 | |a Antigens, Fungal |2 NLM | |
| 700 | 1 | |a Bangdiwala, Ananta S |e verfasserin |4 aut | |
| 700 | 1 | |a Nalintya, Elizabeth |e verfasserin |4 aut | |
| 700 | 1 | |a Kagimu, Enock |e verfasserin |4 aut | |
| 700 | 1 | |a Kasibante, John |e verfasserin |4 aut | |
| 700 | 1 | |a Rutakingirwa, Morris K |e verfasserin |4 aut | |
| 700 | 1 | |a Mpoza, Edward |e verfasserin |4 aut | |
| 700 | 1 | |a Jjunju, Samuel |e verfasserin |4 aut | |
| 700 | 1 | |a Nuwagira, Edwin |e verfasserin |4 aut | |
| 700 | 1 | |a Naluyima, Rose |e verfasserin |4 aut | |
| 700 | 1 | |a Kirumira, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Hou, Cody |e verfasserin |4 aut | |
| 700 | 1 | |a Ssebambulidde, Kenneth |e verfasserin |4 aut | |
| 700 | 1 | |a Musubire, Abdu K |e verfasserin |4 aut | |
| 700 | 1 | |a Williams, Darlisha A |e verfasserin |4 aut | |
| 700 | 1 | |a Abassi, Mahsa |e verfasserin |4 aut | |
| 700 | 1 | |a Muzoora, Conrad |e verfasserin |4 aut | |
| 700 | 1 | |a Hullsiek, Katherine H |e verfasserin |4 aut | |
| 700 | 1 | |a Rajasingham, Radha |e verfasserin |4 aut | |
| 700 | 1 | |a Meya, David B |e verfasserin |4 aut | |
| 700 | 1 | |a Boulware, David R |e verfasserin |4 aut | |
| 700 | 1 | |a Skipper, Caleb P |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Clinical infectious diseases : an official publication of the Infectious Diseases Society of America |d 1992 |g 76(2023), 3 vom: 08. Feb., Seite e759-e765 |w (DE-627)NLM012603007 |x 1537-6591 |7 nnns |
| 773 | 1 | 8 | |g volume:76 |g year:2023 |g number:3 |g day:08 |g month:02 |g pages:e759-e765 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1093/cid/ciac599 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 76 |j 2023 |e 3 |b 08 |c 02 |h e759-e765 | ||