title: Prevalence and outcomes of cryptococcal antigenemia in HIV-seropositive patients hospitalized for suspected tuberculosis in Uganda.
abstract: BACKGROUND
  Cryptococcal infection occurs in HIV-seropositive patients and is associated with high mortality. However, limited information is available on the prevalence and outcomes of cryptococcal antigenemia among hospitalized HIV-seropositive patients in sub-Saharan Africa.
  
  
  OBJECTIVE
  To determine the prevalence of and risk factors for cryptococcal antigenemia among HIV-seropositive patients presenting to Mulago Hospital (Kampala, Uganda) with unexplained cough ≥2 weeks and suspected tuberculosis (TB) and also to determine if antigenemia is associated with an increased mortality.
  
  
  METHODS
  Between September 2009 and September 2010, we enrolled consecutive HIV-seropositive adults hospitalized at Mulago Hospital with cough ≥2 weeks and suspected TB. Banked serum was tested for cryptococcal antigen. We compared demographic and clinical characteristics, and 2-month mortality in patients with and without cryptococcal antigenemia.
  
  
  RESULTS
  Of 563 HIV-seropositive patients, 32 (5.7%) were cryptococcal antigen (CrAg) positive. None had Cryptococcus neoformans detected on fungal culture of bronchoalveolar lavage fluid (n = 116). CrAg-positive patients had a lower median CD4 count compared with CrAg-negative patients (25 vs. 55 cells/μL, P = 0.02), and a substantial proportion of CrAg-positive patients also had concurrent TB (31%). A positive CrAg test was not associated with increased mortality during the 2-month follow-up period (hazard ratio: 0.99, 95% confidence interval: 0.63 to 1.54, P = 0.95) after adjusting for CD4 count and antiretroviral therapy use at enrollment and/or follow-up.
  
  
  CONCLUSIONS
  Occult cryptococcal antigenemia occurs commonly among hospitalized HIV-seropositive patients with suspected TB. CrAg testing should be considered in hospitalized HIV-seropositive patients with CD4 count <50 cells/μL, coupled with longer follow-up to evaluate the diagnostic value of CrAg and therapeutic interventions in patients with asymptomatic cryptococcal antigenemia.
authors.affiliation: Makerere University-University of California, San Francisco Research Collaboration, Kampala, Uganda. andama.alf@gmail.com
authors.forename: Alfred O
authors.initials: AO
authors.lastname: Andama
authors.forename: Saskia
authors.initials: S
authors.lastname: den Boon
authors.forename: David
authors.initials: D
authors.lastname: Meya
authors.forename: Adithya
authors.initials: A
authors.lastname: Cattamanchi
authors.forename: William
authors.initials: W
authors.lastname: Worodria
authors.forename: J Lucian
authors.initials: JL
authors.lastname: Davis
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Walter
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Yoo
authors.forename: Nelson
authors.initials: N
authors.lastname: Kalema
authors.forename: Barbara
authors.initials: B
authors.lastname: Haller
authors.forename: Laurence
authors.initials: L
authors.lastname: Huang
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D000946:Antigens, Fungal / Q000097:blood*; D003453:Cryptococcosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D003454:Cryptococcus / Q000276:immunology / Q000302:isolation & purification; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis; D014454:Uganda / Q000453:epidemiology
chemical_list: D000946:Antigens, Fungal
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