Researchers have identified a high prevalence of cryptococcal
antigenemia among HIV-infected patients hospitalized with acute respiratory
infection in Thailand.
Among HIV-uninfected patients, no cryptococcal pathogens were
identified, whereas 13.1% of HIV-infected patients were identified with
“Health care providers in Thailand should test such patients for
Cryptococcus, because treatment with antifungal agents at this point may
provide a window of opportunity to prevent serious health outcomes,”
Julie R. Harris, PhD, MPH, of the CDC’s Mycotic Diseases Branch,
and colleagues wrote in the study.
Julie R. Harris, PhD, MPH
Researchers aimed to assess Cryptococcus species as a cause of
acute respiratory infection. They examined serum samples from 704 HIV-infected
and 730 HIV-uninfected patients hospitalized with acute respiratory infection
from 2004 to 2009 in two provinces in Thailand.
Of all cryptococcal antigenemia patients, 42.9% never had cryptococcal
meningitis, indicating that they should be tested even in the absence of
Further, antigenemic and nonantigenemic HIV-infected patients had few
clinical differences. “Signs and symptoms alone are insufficient criteria
to determine which hospitalized patients with [acute respiratory infection]
warrant Cryptococcus testing,” according to the researchers.
“A new, rapid and inexpensive point-of-care test for
Cryptococcus that can be used even in resource-limited settings has just
been FDA-approved and might be useful for testing in this setting,” Harris
told Infectious Disease News.
Disclosure: The researchers report no relevant financial
Michael Tapper, MD
An interesting reminder that although opportunistic infections such as
Cryptococcus complicating HIV disease seem a relic of the distant past
in the United States, they are still very much a challenging part of HIV
patient care in the less developed world. As the authors acknowledge, the study
does have a number of limitations, notably the retrospective design, the
failure to isolate Cryptococcus species from all alleged cases of
cryptococcal pneumonia, and the inadequate assessment for infection by
Pneumocystis as an etiology of pneumonia. What is important however, is that
cryptococcal disease in HIV-infected patients (and its most lethal
manifestation; cryptococcal meningitis) represents like Pneumocystis; a
preventable cause of morbidity and mortality in patients with HIV/AIDS. As the
authors note, Thai guidelines for the management of HIV disease already
recommend the prophylactic use of fluconazole for HIV positive patients with
CD4 counts less than 100 mL.
- Michael Tapper, MD
Infectious Disease News Editorial Board member
Disclosure: Dr. Tapper reports no relevant