Cryptococcal antigen testing in an integrated medical system: eastern Wisconsin

Presentation Notes

Presented at North American Primary Care Research Group 46th Annual Meeting; November 9-13, 2018; Chicago, IL.

Abstract

Context: Cryptococcosis is a serious environmentally-acquired endemic fungal infection causing meningitis, pneumonia and disseminated disease in usually immunocompromised hosts. Environmental associations of the pathogenic species include certain trees, soils, bird guano and sites such as parks. Little is known regarding the frequency or distribution of cryptococcosis in Wisconsin. Cryptococcal antigen detection tests (CrAg), more than 90% sensitive and specific, are frequently used to screen patients with likely disease.

Objective: Explore the geodemographic and clinical features of Wisconsin patients tested with CrAg. Study Design: Retrospective review of CrAg-tested patients. Descriptive statistics were compared with chi-square or t-tests; binary logistic regression was used for multivariable analysis. Setting: Large Eastern Wisconsin medical system.

Patients:All patients having CrAg performed 2013-April, 2017.

Results: A total of 1465 CrAg (741 on serum, 723 on CSF, 1 other) were performed on 1211 unique patients (50.2% female, 73.9% White, mean age 53.7 +/-16.5) during this time. At least one CrAg was positive in 23/1211 patients (1.9%); 4 cases had pneumonia only; 21/23 were immunocompromised (6 transplant patients, 5 HIV, 4 malignancy, 3 steroid use, 2 diabetes, 1 combined deficiency). Positive patients were more likely to be male (82.6%) non-White (12/23 [3.8% of those tested] vs 11/23 [1.2% of those tested]), and these associations (both p

Conclusion: Among ill CrAg-tested patients, male gender and non-White race/ethnicity, not natural environmental features, predicted positive tests.

Document Type

Oral/Podium Presentation

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