title: High prevalence of cryptococcal infection among HIV-infected patients hospitalized with pneumonia in Thailand.
abstract: BACKGROUND
  Cryptococcal meningitis (CM) is a major cause of death among HIV-infected patients. Cryptococcal antigenemia (CrAg+) in the absence of CM can represent early-stage cryptococcosis during which antifungal treatment might improve outcomes. However, patients without meningitis are rarely tested for cryptococcal infection. We evaluated Cryptococcus species as a cause of acute respiratory infection in hospitalized patients in Thailand and evaluated clinical characteristics associated with CrAg+.
  
  
  METHODS
  We tested banked serum samples from 704 human immunodeficiency virus (HIV)-infected and 730 HIV-uninfected patients hospitalized with acute respiratory infection from 2004 through 2009 in 2 rural provinces in Thailand for the presence of CrAg+. Retrospective chart reviews were conducted for CrAg+ patients to distinguish meningeal and nonmeningeal cryptococcosis and to identify clinical characteristics associated with CrAg+ in patients with and without evidence of CM.
  
  
  RESULTS
  CrAg+ was found in 92 HIV-infected patients (13.1%); only tuberculosis (19.3%) and rhinovirus (16.5%) were identified more frequently. No HIV-uninfected patients were CrAg+. Of 70 CrAg+ patients with medical charts available, 37 (52.9%) had no evidence of past or existing CM at hospitalization; 30 of those patients (42.9% of all CrAg+) had neither past nor existing CM, nor any alternate etiology of infection identified. Dyspnea was more frequent among CrAg+ patients without CM than among CrAg- patients (P = .0002).
  
  
  CONCLUSIONS
  Cryptococcus species were the most common pathogens detected in HIV-infected patients hospitalized with acute respiratory infection in Thailand. Few clinical differences were found between antigenemic and nonantigenemic HIV-infected patients. Health care providers in Thailand should evaluate HIV-infected patients hospitalized with acute respiratory infection for cryptococcal antigenemia, even in the absence of meningitis.
authors.affiliation: Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. ggt5@cdc.gov
authors.forename: Julie R
authors.initials: JR
authors.lastname: Harris
authors.forename: Mark D
authors.initials: MD
authors.lastname: Lindsley
authors.forename: Sununta
authors.initials: S
authors.lastname: Henchaichon
authors.forename: Natteewan
authors.initials: N
authors.lastname: Poonwan
authors.forename: Sathapana
authors.initials: S
authors.lastname: Naorat
authors.forename: Prabda
authors.initials: P
authors.lastname: Prapasiri
authors.forename: Somrak
authors.initials: S
authors.lastname: Chantra
authors.forename: Fuangrak
authors.initials: F
authors.lastname: Ruamcharoen
authors.forename: Loretta S
authors.initials: LS
authors.lastname: Chang
authors.forename: Malinee
authors.initials: M
authors.lastname: Chittaganpitch
authors.forename: Nanthawan
authors.initials: N
authors.lastname: Mehta
authors.forename: Leonard
authors.initials: L
authors.lastname: Peruski
authors.forename: Susan A
authors.initials: SA
authors.lastname: Maloney
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
authors.forename: Henry C
authors.initials: HC
authors.lastname: Baggett
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000946:Antigens, Fungal / Q000097:blood / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003453:Cryptococcosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D003454:Cryptococcus / Q000276:immunology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000946:Antigens, Fungal