Cryptococcal antigenemia prevalence and clinical data in HIV‐infected patients from the reference center at INI‐FIOCRUZ, Rio de Janeiro, Southeast of Brazil
Marcela de F. Ferreira  Fabio Brito‐Santos  Luciana Trilles  Marcos A. Almeida  Bodo Wanke  Valdilea G. Veloso  Estevao P. Nunes  Marcia dos S. Lazera
First published: 12 November 2019 https://doi.org/10.1111/myc.13032
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Abstract
Background
Cryptococcal meningitis is a severe disease common in late stage of HIV infection. Detection of cryptococcal antigen (CrAg) is an important for early diagnosis of this invasive mycosis. The pre‐emptive treatment for isolated antigenemia prevents the onset of meningitis. Screening CrAg in patients with low CD4 count is cost‐effective in countries with prevalence of antigenemia above 3%. However, in Brazil, the number of prevalence studies on cryptococcosis and HIV is insufficient.

Objectives
Estimate the prevalence of CrAg and describe clinical characteristics from a cohort of patients followed at a reference center in Brazil.

Methods
CrAg screening was performed in 89 inpatients with CD4 count ≤200 cells/mm3 or WHO stage III/IV from the National Institute of Infectious Disease, Rio de Janeiro. Patients with isolated antigenemia received pre‐emptive therapy with fluconazole and patients with meningitis were treated with Amphotericin B. Individuals were followed up for 12 months.

Results
Prevalence of serum CrAg was 11.2%, cryptococcal meningitis 6.7% and isolated antigenemia 4.8%. None of the patients with isolated antigenemia developed meningitis during the follow up. Signs and symptoms of meningitis were unspecific or absent.

Conclusions
our study suggests the need of CrAg screening in Brazil and highlights that lumbar puncture is mandatory in all individuals CrAg positive to exclude asymptomatic meningitis.

Supporting Information