15
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Cryptococcal Antigenemia in Advanced Human Immunodeficiency Virus Disease: Pathophysiology, Epidemiology, and Clinical Implications

      review-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Cryptococcal antigen (CrAg) is detectable in blood prior to the onset of symptomatic cryptococcal meningitis (CM), a leading cause of death among people with advanced human immunodeficiency virus (HIV) disease globally. Highly sensitive assays can detect CrAg in blood, and screening people with HIV with low CD4 counts, followed by preemptive antifungal treatment, is recommended and widely implemented as part of a global strategy to prevent CM and end cryptococcal-related deaths. Cryptococcal antigenemia encompasses a spectrum of conditions from preclinical asymptomatic infection (cerebrospinal fluid [CSF] CrAg-negative) through subclinical (CSF CrAg-positive without overt meningism) to clinical symptomatic cryptococcal disease, usually manifesting as CM. In this review, we summarize current understanding of the pathophysiology, risk factors for, and clinical implications of cryptococcal antigenemia within this spectrum. We also provide an update on global prevalence, recommended screening and treatment strategies, and future considerations for improving outcomes among patients with cryptococcal antigenemia.

          Abstract

          In this review, we summarize our current understanding of cryptococcal antigenemia as reactivated latent cryptococcal infection, encompassing a spectrum of clinically recognized conditions. Optimization of screening and management strategies is required to prevent cryptococcal meningitis and end cryptococcal-related deaths.

          Related collections

          Most cited references52

          • Record: found
          • Abstract: found
          • Article: not found

          Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis.

          Cryptococcus is the most common cause of meningitis in adults living with HIV in sub-Saharan Africa. Global burden estimates are crucial to guide prevention strategies and to determine treatment needs, and we aimed to provide an updated estimate of global incidence of HIV-associated cryptococcal disease.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Cryptococcus: from environmental saprophyte to global pathogen.

            Cryptococcosis is a globally distributed invasive fungal infection that is caused by species within the genus Cryptococcus which presents substantial therapeutic challenges. Although natural human-to-human transmission has never been observed, recent work has identified multiple virulence mechanisms that enable cryptococci to infect, disseminate within and ultimately kill their human host. In this Review, we describe these recent discoveries that illustrate the intricacy of host-pathogen interactions and reveal new details about the host immune responses that either help to protect against disease or increase host susceptibility. In addition, we discuss how this improved understanding of both the host and the pathogen informs potential new avenues for therapeutic development.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found

              Antifungal Combinations for Treatment of Cryptococcal Meningitis in Africa

                Bookmark

                Author and article information

                Contributors
                Journal
                Clin Infect Dis
                Clin Infect Dis
                cid
                Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
                Oxford University Press (US )
                1058-4838
                1537-6591
                15 February 2023
                20 August 2022
                20 August 2022
                : 76
                : 4
                : 764-770
                Affiliations
                Institute for Infection and Immunity, St George’s University of London , London, United Kingdom
                Clinical Academic Group in Infection and Immunity, St George’s University Hospitals National Health Service Foundation Trust , London, United Kingdom
                Institute for Infection and Immunity, St George’s University of London , London, United Kingdom
                Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa
                Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine , London, United Kingdom
                Botswana Harvard AIDS Institute Partnership , Gaborone, Botswana
                Institute for Infection and Immunity, St George’s University of London , London, United Kingdom
                Clinical Academic Group in Infection and Immunity, St George’s University Hospitals National Health Service Foundation Trust , London, United Kingdom
                MRC Centre for Medical Mycology, University of Exeter , Exeter, United Kingdom
                Institute for Infection and Immunity, St George’s University of London , London, United Kingdom
                Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa
                MRC Centre for Medical Mycology, University of Exeter , Exeter, United Kingdom
                Division of the National Health Laboratory Service, Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases , Johannesburg, South Africa
                Division of Medical Microbiology, University of Cape Town , Cape Town, South Africa
                Author notes
                Correspondence: R. Wake, Institute for Infection and Immunity, St George’s University of London, Cranmer Terrace, London, SW17 0RE, UK ( rmwake@ 123456gmail.com ).

                Potential conflicts of interest. J. J. reports grants or contracts from European and Developing Countries Clinical Trials (EDCTP) and Center for Disease Control (CDC) (paid to institution) and speaker fees from Gilead Sciences, Inc, and reports serving as chair of a data and safety monitoring board (DSMB) for the ARTIST trial, Harvest trial, and CASTLE trial. T. H. reports speaker fees from Gilead Sciences, Inc and Pfizer and reports grants or contracts from Medical Research Council (MRC), Wellcome Trust (WT), Department for International Development (DFID) Global Health Trials, and EFFECT Trial (paid to institution). N. G. reports grants from National Institute for Health and Care Research (NIHR), CDC, National Institutes of Health (NIH), Gates Foundation, and National Health Laboratory Service (NHLS) Research Trust (paid to institution) and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from SA HIV Clinicians Society (paid to author); reports servings as a DSMB member for the ACACIA trial, an advisory board member for 5FC-Crypto, and an advisory board chair for DREAMM; is the president and council member for Federation of Infectious Diseases Societies of Southern Africa (FIDSSA), a member of the CryptoMAG, Ambassador for GAFFI, a board member for the Medical Mycology Society Nigeria, and a member for LIGHT Africa; and includes receipt of equipment, materials, drugs, medical writing, gifts, or other services from Immy CrAg tests and OIDx Histoplasma antigen tests (paid to institution). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

                Author information
                https://orcid.org/0000-0003-3193-4888
                Article
                ciac675
                10.1093/cid/ciac675
                9938740
                35986670
                b5b03620-d79d-4318-9241-bf668a47b742
                © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 09 June 2022
                : 12 August 2022
                : 26 September 2022
                Page count
                Pages: 7
                Funding
                Funded by: Health Education England;
                Funded by: NIHR, doi 10.13039/501100000272;
                Award ID: CL-2019-16-001
                Funded by: Global Health, doi 10.13039/100006090;
                Award ID: RP-2017-08-ST2-012
                Funded by: UK government, doi 10.13039/100013986;
                Funded by: National Institutes of Health, doi 10.13039/100000002;
                Award ID: 1R01AI118511-01A1
                Funded by: Joint Global Health Scheme with funding from the UK Foreign;
                Funded by: Medical Research Council, doi 10.13039/501100000265;
                Funded by: Wellcome, doi 10.13039/100004440;
                Award ID: MR/V005731/1
                Categories
                Review Article
                Immunocompromised Hosts
                AcademicSubjects/MED00290

                Infectious disease & Microbiology
                cryptococcal meningitis,cryptococcosis,diagnostic screening programs,acquired immunodeficiency syndrome,hiv

                Comments

                Comment on this article