ABSTRACT

Introduction

Cryptococcal meningitis remains a significant contributor to AIDS-related mortality despite widened access to antiretroviral therapy. Cryptococcal antigen (CrAg) can be detected in the blood prior to development of meningitis. Development of highly sensitive and specific rapid diagnostic CrAg tests has helped facilitate the adoption of CrAg screening programs in 19 African countries.

Areas covered

The biological rationale for CrAg screening and the programmatic strategies for its implementation are reviewed. We describe the approach to the investigation of patients with cryptococcal antigenemia and the importance of lumbar puncture to identify individuals who may have cryptococcal meningitis in the absence of symptoms. The limitations of current treatment recommendations and the potential role of newly defined combination antifungal therapies are discussed. A literature review was conducted using a broad database search for cryptococcal antigen screening and related terms in published journal articles dating up to December 2019. Conference abstracts, publicly available guidelines, and project descriptions were also incorporated.

Expert opinion

As we learn more about the risks of cryptococcal antigenemia, it has become clear that the current management paradigm is inadequate. More intensive investigation and management are required to prevent the development of cryptococcal meningitis and reduce mortality associated with cryptococcal antigenemia.

中文翻译：

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隐球菌脑膜炎：非洲隐球菌抗原筛查项目综述

摘要

介绍

尽管扩大了抗逆转录病毒疗法的可及性，但隐球菌脑膜炎仍然是导致艾滋病相关死亡率的重要因素。在发生脑膜炎之前，可以在血液中检测到隐球菌抗原 (CrAg)。高度敏感和特异的快速诊断 CrAg 测试的发展有助于促进 19 个非洲国家采用 CrAg 筛查计划。

覆盖区域

回顾了 CrAg 筛查的生物学原理及其实施的规划策略。我们描述了对隐球菌抗原血症患者进行调查的方法以及腰椎穿刺以确定可能患有隐球菌性脑膜炎而没有症状的个体的重要性。讨论了当前治疗建议的局限性以及新定义的联合抗真菌疗法的潜在作用。使用广泛的数据库搜索对 2019 年 12 月之前已发表的期刊文章中的隐球菌抗原筛查和相关术语进行了文献综述。还纳入了会议摘要、公开指南和项目描述。

专家意见

随着我们对隐球菌抗原血症风险的了解越来越多，很明显当前的管理范式是不够的。需要更深入的调查和管理以防止隐球菌脑膜炎的发展并降低与隐球菌抗原血症相关的死亡率。