Culture- and direct microscopy-negative AIDS-related cryptococcosis before and during the highly active antiretroviral therapy (HAART) era

Manfredi, R. L. Calza, F. Chiodo (Bologna, I)


Objective. To assess the frequency and clinical features of AIDS-related cryptococcosis (C) diagnosed by an isolated positive antigen (Ag) testing. Methods. A cryptococcal Ag latex agglutination assay was included in the diagnostic workup for all HIV-infected patients (p) with suspected C or fever of unknown origin, since 1992. Results. Of 37 p with C diagnosed since 1992, 8 (21.6%) were initially identified by an isolated positive Ag assay: 5 cases of 32 (15.6%) in the pre-HAART era (1992-1996), and 3 cases of 5 (60%) in the HAART period (since 1997); in 7 cases of 8, C was the AIDS-defining event. Compared with the pre-HAART era, during the last 4 years this feature became increasingly frequent (p<.001 interested="" p="" with="" a="" higher="" mean="" cd4="" count="" vs.="" cells="" and="" occurred="" in="" absence="" of="" prior="" antifungal="" use="" out="" cases="" the="" pre-haart="" era="" an="" isolated="" positive="" ag="" assay="" involved="" only="" cerebrospinal="" fluid="" all="" diagnosed="" until="" while="" serum="" testing="" followed="" since="" despite="" suggestive="" clinical="" picture="" had="" repeatedly="" negative="" direct="" microscopy="" cultures.="" immediately="" after="" obtaining="" underwent="" systemic="" therapy:="" died="" few="" days="" necropsy="" findings="" confirming="" c="" late="" relapses="" association="" blood="" or="" csf="" culture="" identified="" were="" cured.="" discussion.="" cryptococcal="" represents="" rare="" event="" particular="" but="" it="" became="" increasingly="" frequent="" some="" features="" changed="" haart="" use:="" less="" severe="" immunodeficiency="" therapy="" involvement="" compared="" improved="" prognosis="" lethal="" relapsing="" is="" notably="" sensitive="" specific="" warrant="" timely="" treatment="" prolonged="" monitoring="" order="" to="" avoid="" life-threatening="" disease.="" increased="" as="" screening="" procedure="" pathomorphism="" caused="" by="" both="" anti-hiv="" may="" support="" apparent="" increase="" this="" phenomenon.="" most="" literature="" reports="" pointed="" abnormal="" laboratory="" aids-related="" so="" that="" persistingly="" studies="" cannot="" exclude="" especially="" era.="">

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11th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 11th (2001)