Cryptococcal Antigen in Serum and Cerebrospinal Fluid for Detecting Cryptococcal Meningitis in Adults Living With Human Immunodeficiency Virus: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies.

Autor:	Temfack E; Institut Pasteur, Centre National de la Recherche Scientifique, Molecular Mycology Unit Unite Mixte de Recherche 2000, Paris, France.; Internal Medicine Unit, Douala General Hospital, Douala, Cameroon., Rim JJB; Epidemiology Department, Centre Pasteur du Cameroun, Yaounde, Cameroon., Spijker R; Cochrane Netherlands, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands., Loyse A; Institute of Infection and Immunity, St. George's University of London, London, United Kingdom.; Department of Infection, St George's University Hospitals National Health Service Trust, London, United Kingdom.; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa., Chiller T; Tulane School of Public Health and Tropical Medicine, Atlanta, Georgia, USA., Pappas PG; Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA., Perfect J; Division of Infectious Diseases, Department of Medicine, Duke University Medical Centre, Durham, North Carolina, USA., Sorell TC; University of Sydney Faculty of Medicine and Health, Westmead Clinical School and Centre for Infectious Diseases and Microbiology, The Westmead Institute of Medical Research, Westmead, Australia., Harrison TS; Institute of Infection and Immunity, St. George's University of London, London, United Kingdom.; Department of Infection, St George's University Hospitals National Health Service Trust, London, United Kingdom.; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa., Cohen JF; Institut National de la Sante et de la Recherche Medicale UMR 1153 Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France.; Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital, Assistance Publique-Hopitaux de Paris. Paris Descartes University, Paris, France., Lortholary O; Institut Pasteur, Centre National de la Recherche Scientifique, Molecular Mycology Unit Unite Mixte de Recherche 2000, Paris, France.; University Paris Descartes, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, Hôpital Necker - Enfants malades, Assistance Publique-Hopitaux de Paris, Institut Hospitalo-Universitaire Imagine, Paris, France.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2021 Apr 08; Vol. 72 (7), pp. 1268-1278.
DOI:	10.1093/cid/ciaa1243
Abstrakt:	Cryptococcal antigen (CrAg) detection could direct the timely initiation of antifungal therapy. We searched MEDLINE and Embase for studies where CrAg detection in serum/cerebrospinal fluid (CSF) and CSF fungal culture were done on adults living with human immunodeficiency virus (HIV) who had suspected cryptococcal meningitis (CM). With Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), we evaluated the risk of bias in 11 included studies with 3600 participants, and used a random-effects meta-analysis to obtain summary sensitivity and specificity of serum and CSF CrAg, as well as agreement between CSF CrAg and CSF culture. Summary sensitivity and specificity of serum CrAg were 99.7% (97.4-100) and 94.1% (88.3-98.1), respectively, and summary sensitivity and specificity of CSF CrAg were 98.8% (96.2-99.6) and 99.3% (96.7-99.9), respectively. Agreement between CSF CrAg and CSF culture was 98% (97-99). In adults living with HIV who have CM symptoms, serum CrAg negativity may rule out CM, while positivity should prompt induction antifungal therapy if lumbar puncture is not feasible. In a first episode of CM, CSF CrAg positivity is diagnostic. (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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