Cryptococcus common cause of respiratory infection among HIV patients

Harris JR. Clin Infect Dis. 2011;doi:10.1093/cid/cir903.

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 cryptococcal antigenemia.

“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
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 meningitis.

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 disclosures.


PERSPECTIVE

Michael Tapper, MD
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 financial disclosures.

Twitter Follow InfectiousDiseaseNews.com on Twitter.

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 cryptococcal antigenemia.

“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
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 meningitis.

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 disclosures.


PERSPECTIVE

Michael Tapper, MD
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 financial disclosures.

Twitter Follow InfectiousDiseaseNews.com on Twitter.