![]() Unlike with other opportunistic infections, ART initiation generally is deferred for 4 to 6 weeks after antifungal agents are started ( AI). 12, 13, 45 Special Considerations with Regard to Starting ART If serum CrAg titers are >1:640 with the LFA test and a CSF sample is not available, CNS involvement should be assumed regardless of CSF culture results or clinical signs or symptoms, and the patient should be treated as detailed above for CNS disease ( AII). 13 All patients with asymptomatic cryptococcal antigenemia should have their CSF sampled to rule out CNS disease. 14-16 False negative results have been noted to occur when there is a low burden of organisms in one study, when there were 1:160 by EIA or latex agglutination), even in the absence of meningitis, the risk for mortality and/or progression to meningitis increases with fluconazole monotherapy alone, and patients should be treated the same as patients with cryptococcal meningitis (BIII). gattii, and performs well in infections with a moderate to high fungal burden. This multiplex PCR tests for 14 targets, including C. ![]() In 2016, the BioFire FilmArray Meningitis/Encephalitis Panel PCR assay (Biofire Diagnostics, Salt Lake City, UT) was approved by the FDA. 12, 13 Antigen titers by the LFA are approximately fourfold higher than those with latex agglutination or EIA testing, thus a titer of 1:640 by LFA is approximately equal to a titer of 1:160 by EIA or latex agglutination. 3 Overall, 90% of cryptococcal cases in people with HIV 4 are observed in those who have CD4 T lymphocyte (CD4) cell counts 1:160, disseminated disease becomes increasingly more likely, and when CrAg LFA titers are >1:640, disseminated and/or CNS involvement should be assumed, regardless of CSF test results. 2 Current estimates indicate that every year, approximately 280,000 cases of cryptococcal infection in people with AIDS occur worldwide, and the disease accounts for 15% of AIDS-related deaths. 1 In a surveillance study in the late 1990s, people with HIV who developed cryptococcosis were severely immunosuppressed and had limited access to routine HIV medical care. ![]() Before the era of effective antiretroviral therapy (ART), approximately 5% to 8% of patients with HIV in high-income countries had disseminated cryptococcosis. gattii most often is found in Australia and similar subtropical regions and in the Pacific Northwest. neoformans is found worldwide, whereas C. Most HIV-associated cryptococcal infections are caused by Cryptococcus neoformans, but occasionally Cryptococcus gattii is the cause.
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