title: Cryptococcosis in HIV-infected hospitalized patients in Germany: Evidence for routine antigen testing.
abstract: OBJECTIVE
  To investigate the diagnostic value of routine cryptococcal antigen (CRAG) testing in HIV-infected patients in a low prevalence setting.
  
  
  METHODS
  Retrospective single centre cohort study of a 10-year period (2005-2014).
  
  
  RESULTS
  5461 patients tested for CRAG were included. Cryptococcal antigenaemia was found in 1.6% and 1.1% of patients with CD4 counts of ≤100/μl and 101-200/μl, respectively. The positive predictive values for identifying clinically relevant cryptococcal disease was 96% and 100%, respectively. Half of the patients had a non-specific presentation and median time-to-diagnosis was high (5 days, range 1-44 days). The median time-to-diagnosis in direct admissions to our centre with routine CRAG testing was significantly shorter: 1 day (range: 1-17) vs. 7 days (range: 2-44), p = 0.003. Prevalence of cryptococcal antigenaemia was 2.8% in patients with pneumocystis pneumonia and median time-to-diagnosis of cryptococcosis was significantly longer in this subgroup (15 days; range: 1-44 vs. 3 days; range: 1-17; p = 0.008). CRAG titres ≥1:512 were associated with disseminated disease (OR 21.3, p = 0.0008, 95% CI 1.64-277), however, 10% of patients with disseminated cryptococcosis had CRAG titres <1:16.
  
  
  CONCLUSIONS
  Our data support routine CRAG testing in hospitalized HIV-infected patients with CD4 counts ≤200/μl, and/or pneumocystis pneumonia.
authors: Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany. Electronic address: juri.katchanov@icloud.com.
authors: Juri
authors: J
authors: Katchanov
authors: Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany.
authors: Laura
authors: L
authors: Jefferys
authors: Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany.
authors: Daniela
authors: D
authors: Tominski
authors: Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany.
authors: Kai
authors: K
authors: Wöstmann
authors: Septomics Research Center, Jena University Hospital, Germany.
authors: Hortense
authors: H
authors: Slevogt
authors: Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany.
authors: Keikawus
authors: K
authors: Arastéh
authors: Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany.
authors: Hartmut
authors: H
authors: Stocker
mesh_terms: D000328:Adult; D000946:Antigens, Fungal / Q000097:blood*; D018791:CD4 Lymphocyte Count; D003453:Cryptococcosis / Q000175:diagnosis / Q000453:epidemiology*; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000946:Antigens, Fungal
keywords: AIDS; Cryptococcal antigenaemia; Cryptococcosis; HIV