Preemptive Therapy in Cryptococcosis Adjusted for Outcomes

Abstract

Cryptococcosis is one of the most serious opportunistic diseases in patients living with HIV. For this reason, early diagnosis and appropriate treatment are important.

Objectives: The aim of the study was to understand the development of patients diagnosed with cryptococcosis by detection of Cryptococcus antigen in serum by lateral flow assay (CrAg LFA) without nervous system involvement and with treatment in accordance with the results.

Materials and methods: A retrospective, longitudinal, analytical study was performed. Seventy patients with cryptococcosis initially diagnosed by serum CrAg LFA without meningeal involvement between January 2019 and April 2022 were analyzed for medical records. The treatment regimen was adapted to the results of blood culture, respiratory material, and pulmonary tomography imaging.

Results: Seventy patients were included, 13 had probable pulmonary cryptococcosis, 4 had proven pulmonary cryptococcosis, 3 had fungemia, and 50 had preemptive therapy without microbiological or imaging findings compatible with cryptococcosis. Among the 50 patients with preemptive therapy, none had meningeal involvement or cryptococcosis recurrences to date.

Conclusion: Preemptive therapy avoided progression to meningitis in CrAg LFA-positive patients. Preemptive therapy with dose adjustment of fluconazole in patients with the mentioned characteristics was useful despite the use of lower doses than recommended.

Keywords: Cryptococcus; cryptococcal antigenemia; cryptococcal screening; lateral flow assay; preemptive therapy; serum cryptococcal antigen.

Figure 1

Flow chart with patients included and final results.

Figure 2

Methodologies used for diagnosis and treatment.

Figure 3

(a) Small thin-walled cavity and pulmonary nodules in patient with proven CP. (b) Chest CT scan, coronal image showing interstitial pattern with ground-glass view.