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Detection of Cryptococcal Antigen in Bronchoalveolar Lavage Fluid: A Prospective Study of Diagnostic Utility
Abstract
Cryptococcal pneumonia is associated with significant morbidity and mortality in immunocompromised patients. We examined the utility of screening bronchoalveolar lavage (BAL) fluid for cryptococcal antigen. In a pilot study, we found that cryptococcal antigen was always positive in unprocessed BAL specimens of seven patients with cryptococcal pneumonia and negative in 44 patients with other granulomatous diseases who acted as the control subjects. A prospective study was done of 220 immunocompromised patients (188 with human immunodeficiency virus infection, 32 with other causes of immunosuppression) undergoing BAL for fever and pulmonary symptoms. The eventual diagnosis of cryptococcal pneumonia was made in eight patients. All eight patients had a cryptococcal antigen titer greater than or equal to 1:8. There were four patients without cryptococcal pneumonia who had cryptococcal antigen titers of 1:8, there were none with higher titers. For a titer of cryptococcal antigen titer of greater than or equal to 1:8, there was 100% sensitivity, 98% specificity, a positive predictive value of 67%, and a negative predictive value of 100%. The measurement of cryptococcal antigen in the BAL can be a rapid, simple way to make a diagnosis of cryptococcal pneumonia in immunosuppressed patients with pneumonia.
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“We identified direct evidence from three RCTs that compared procalcitonin-guided protocols for antibiotic initiation vs usual care (129-131).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [131]
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935
Cryptococcosis in the era of AIDS--100 years after the discovery of Cryptococcus neoformans
Mitchell, T. G., & Perfect, J. R. (1995) · Clinical Microbiology Reviews · doi:10.1128/cmr.8.4.515 · Cited by 1,213
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082
Metadata
- Authors
- Baughman, R. P., Rhodes, J. C., Dohn, M. N., Henderson, H., & Frame, P. T.
- Affiliations
- University of Cincinnati Medical Center (US)
- Venue
- American Review of Respiratory Disease
- Publisher
- Oxford University Press (OUP)
- Published
- 1992-05-01
- Volume
- 145
- Issue
- 5
- Pages
- 1226-1229
- ISSN
- 0003-0805 (ISSN-L)
- OpenAlex
- W2029383736
- Cited by
- 77
- References
- 0
- Citations by year
- 2026: 1 · 2024: 1 · 2021: 5 · 2020: 3 · 2019: 1 · 2018: 2 · 2017: 3 · 2016: 4 · 2015: 5 · 2014: 4 · 2012: 2
- FWCI
- 3.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Review of Respiratory Disease (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5m01rr000068-27)
- National Institute of Allergy and Infectious Diseases (AI 25897, U01AI025897)
- National Center for Research Resources (RR00068)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Fungal Infections and Studies
- Health Sciences › Medicine › Epidemiology › Pneumocystis jirovecii pneumonia detection and treatment
- Life Sciences › Immunology and Microbiology › Parasitology › Parasitic Infections and Diagnostics
- Keywords
- cryptococcal antigen, cryptococcal pneumonia, bronchoalveolar lavage fluid, immunocompromised patients, HIV infection, sensitivity and specificity, pulmonary cryptococcosis, granulomatous disease
- MeSH terms
- Acquired Immunodeficiency Syndrome, Adult, Antigens, Fungal, Bronchoalveolar Lavage Fluid, Cryptococcosis, Humans, Lung Diseases, Fungal, Middle Aged, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Immunocompromised Host
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