There is scarce information about HIV-related cryptococcosis in the Brazilian Amazon basin where laboratory infrastructure is limited. The serum cryptococcal antigen (CrAg) lateral flow assay (LFA) has simplified diagnosis of cryptococcosis and is recommended for screening in advanced HIV disease. We evaluated the prevalence of cryptococcal antigenemia using finger-prick CrAg LFA in the Brazilian Amazon basin. We enrolled a prospective cohort of outpatients and hospitalized individuals with advanced HIV disease at two centers in Santarém Municipality, Northern Brazil. All individuals were > 18 years old with advanced HIV disease, regardless of antiretroviral therapy (ART) status and with no prior or current history of confirmed cryptococcal meningitis. We tested CrAg LFA on finger-prick whole blood using an exact volume transfer pipette. From August 2018 to October 2019, 104 individuals were enrolled (outpatients 62 [60%] and hospitalized 42 [40%]). Median age was 38 years (interquartile range [IQR] 30-46), and 84 (81%) were male. Sixty-five (63%) individuals were ART-naïve. Prevalence of finger-prick CrAg LFA-positive was 10.6%; 95% CI, 5.4 to 18.1%. Prevalence of finger-prick CrAg LFA-positive among individuals without neurological symptoms was 6.0%; 95% CI, 1.7-14.6%. The number needed to test to detect one CrAg-positive individual was 9.4 persons (95% CI, 5.5-18.5). Prevalence of cryptococcal antigenemia using finger-prick whole blood CrAg LFA was high. Point-of-care approach was important for the diagnosis and screening of cryptococcosis in resource-limited settings. Screening and preemptive therapy strategy should be urgently implemented in individuals with advanced HIV disease in the Brazilian Amazon basin. This prospective cohort study was carried-out in the Brazilian Amazon basin. We used a cryptococcal rapid test in patients with AIDS. We included 104 participants, and 11 (10.6%) of them had positive results showing a high prevalence of cryptococcal antigenemia.

中文翻译：

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在巴西亚马逊河流域圣塔伦市，晚期手指感染者使用手指刺入侧向血流分析法检测隐球菌抗原血症的患病率较高。

在实验室基础设施有限的巴西亚马逊流域，关于艾滋病毒相关隐球菌病的信息很少。血清隐球菌抗原（CrAg）侧向血流测定（LFA）简化了隐球菌病的诊断，建议用于晚期HIV疾病的筛查。我们在巴西亚马逊河流域使用手指刺穿CrAg LFA评估了隐球菌抗原血症的患病率。我们在巴西北部圣塔伦市的两个中心招募了一个前瞻性队列研究对象，其中包括患有晚期艾滋病毒的门诊患者和住院患者。不论抗逆转录病毒疗法（ART）的状态如何，都没有18岁以上的晚期HIV病史，也没有既往或当前确诊的隐球菌脑膜炎病史。我们使用精确的体积移液管在手指刺入的全血中测试了CrAg LFA。从2018年8月到2019年10月，共有104人入组（门诊患者62 [60％]，住院42 [40％]）。中位年龄为38岁（四分位间距[IQR] 30-46），男性为84岁（81％）。百分之六十五（63％）的人是初次使用ART的人。指刺CrAg LFA阳性的患病率为10.6％；95％CI，5.4％至18.1％。在无神经系统症状的个体中，指刺CrAg LFA阳性的患病率为6.0％；95％CI，1.7-4.6.6％。检测一名CrAg阳性个体所需的测试人数为9.4人（95％CI，5.5-18.5）。使用手指刺全血CrAg LFA的隐球菌抗原血症的患病率很高。现场护理方法对于资源有限的隐球菌病的诊断和筛查非常重要。在巴西亚马逊河流域，患有艾滋病毒的晚期患者应紧急实施筛查和先发疗法策略。这项前瞻性队列研究在巴西亚马逊流域进行。我们对艾滋病患者进行了隐球菌快速检测。我们包括104名参与者，其中11名（10.6％）的阳性结果表明隐球菌抗原血症的患病率很高。