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Screening for invasive fungal disease using non-culture-based assays among inpatients with advanced HIV disease at a large academic hospital in South Africa.
- Source :
-
Mycoses [Mycoses] 2020 May; Vol. 63 (5), pp. 478-487. Date of Electronic Publication: 2020 Mar 20. - Publication Year :
- 2020
-
Abstract
- Introduction: Despite widespread access to antiretroviral therapy (ART), the burden of advanced HIV disease in South Africa is high. This translates into an increased risk of AIDS-related opportunistic infections, including invasive mycoses.<br />Methods: Using a limited number of non-culture-based diagnostic assays, we aimed to determine the prevalence of invasive mycoses and tuberculosis among hospitalised adults with very advanced HIV (CD4 counts < 100 cells/µL) at a large academic hospital. We conducted interviews and prospective medical chart reviews. We performed point-of-care finger stick and serum cryptococcal antigen lateral flow assays; serum (1 → 3) ß-D-glucan assays; urine Histoplasma galactomannan antigen enzyme immunoassays and TB lipoarabinomannan assays.<br />Results: We enrolled 189 participants from 5280 screened inpatients. Fifty-eight per cent were female, with median age 37 years (IQR: 30-43) and median CD4 count 32 cells/µL (IQR: 13-63). At enrolment, 60% (109/181) were receiving ART. Twenty-one participants (11%) had a diagnosis of an invasive mycosis, of whom 53% (11/21) had cryptococcal disease. Thirteen participants (7%) had tuberculosis and a concurrent invasive mycosis. ART-experienced participants were 60% less likely to have an invasive mycosis than those ART-naïve (adjusted OR: 0.4; 95% CI 0.15-1.0; P = .03). Overall in-hospital mortality was 13% (invasive mycosis: 10% [95% CI 1.2-30.7] versus other diagnoses: 13% (95% CI 8.4-19.3)).<br />Conclusions: One in ten participants had evidence of an invasive mycosis. Diagnosis of proven invasive fungal disease and differentiation from other opportunistic infections was challenging. More fungal-specific screening and diagnostic tests should be applied to inpatients with advanced HIV disease.<br /> (© 2020 Blackwell Verlag GmbH.)
- Subjects :
- AIDS-Related Opportunistic Infections epidemiology
Academic Medical Centers
Adult
Antigens, Fungal blood
Antigens, Fungal urine
Cross-Sectional Studies
Cryptococcosis diagnosis
Cryptococcosis epidemiology
Female
HIV Infections microbiology
Histoplasmosis diagnosis
Histoplasmosis epidemiology
Humans
Inpatients
Invasive Fungal Infections epidemiology
Lipopolysaccharides blood
Male
Point-of-Care Systems
Prevalence
Prospective Studies
South Africa
Tuberculosis diagnosis
Tuberculosis epidemiology
AIDS-Related Opportunistic Infections diagnosis
HIV Infections complications
Invasive Fungal Infections diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1439-0507
- Volume :
- 63
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Mycoses
- Publication Type :
- Academic Journal
- Accession number :
- 32125004
- Full Text :
- https://doi.org/10.1111/myc.13071