High prevalence of central nervous system cryptococcosis using a fingerprick whole-blood lateral flow assay in individuals with neurological symptoms and advanced HIV disease in a Brazilian emergency department.

Autor:	Oliveira FG; Departamento de Infectologia, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil., Nakagawa JAS; Departamento de Infectologia, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil., de Oliveira JMM; Departamento de Infectologia, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil., Júnior RML; Departamento de Infectologia, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil., Marcusso R; Departamento de Neurologia, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil., Vidal JE; Departamento de Neurologia, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.; Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.; Laboratório de Investigação Médica (LIM 49) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	Medical mycology [Med Mycol] 2023 Sep 04; Vol. 61 (9).
DOI:	10.1093/mmy/myad093
Abstrakt:	Timely diagnosis is key in managing central nervous system (CNS) cryptococcosis in people living with HIV/AIDS (PLWHA). There are few data on implementing fingerprick whole-blood cryptococcal antigen (CrAg) lateral flow assay (LFA) as the first test for diagnosing CNS cryptococcosis. We evaluated the prevalence of CNS cryptococcosis and cryptococcal antigenemia using fingerprick whole-blood in a referral emergency department (ED) in São Paulo, Brazil. This was a prospective cohort study of consecutive adult PLWHA with advanced HIV disease and neurological symptoms. Fingerprick whole-blood CrAg LFA was performed at bedside. Seventy-four individuals were enrolled (median age = 40 years; males = 62%). Prevalence of CNS cryptococcosis was 17.6% (13/74); 95% confidence interval (CI), 9.4-30.0%, and prevalence of positive fingerprick whole-blood CrAg LFA was 25.7% (19/74); 95% CI, 15.5-40.1%. Among the six (8.1%) patients with positive fingerprick whole-blood CrAg LFA and negative CSF CrAg LFA, four (5.4%) had isolated asymptomatic cryptococcal antigenemia, one (1.3%) had symptomatic cryptococcal antigenemia, and one (1.3%) had cryptococcemia. Prevalence of CNS cryptococcosis and cryptococcal antigenemia using fingerprick whole-blood CrAg LFA was high. Point-of-care testing was important for diagnosing CNS cryptococcosis in an ED from a middle-income country. (© The Author(s) 2023. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)
Databáze:	MEDLINE
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