Emerging Infections Network Survey of Screening for Cryptococcal Antigenemia, United States, 2024

Author: mycolabadmin
7/1/2025
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Summary

Researchers surveyed infectious disease doctors across the United States about their use of a blood test (cryptococcal antigen screening) to detect a serious fungal infection in HIV patients before symptoms appear. Only about one-third to two-thirds of doctors regularly perform this inexpensive and accurate test, depending on the patient’s immune system status. Many doctors were unsure about the benefits and guidelines for this screening, suggesting that education and clearer guidelines could help more patients catch this dangerous infection early and receive treatment before it becomes life-threatening.

Background

Cryptococcosis is a severe fungal infection caused by Cryptococcus, with approximately 3.4-6.5 cases per 100,000 population annually in the United States. About one-third of cryptococcosis patients have HIV, and cryptococcal antigen (CrAg) testing can detect early asymptomatic infection weeks to months before symptom onset. US federal guidelines recommend routine CrAg screening for persons with HIV and CD4 counts ≤200 cells/mm³, but limited data exist about CrAg screening practices in the United States.

Objective

To assess the current practices and barriers to cryptococcal antigen screening among infectious disease specialists in the United States. The study aimed to identify potential gaps between clinical recommendations and actual screening practices.

Results

Only 33% of respondents reported typically obtaining CrAg screening for patients with CD4 counts <200 cells/mm³, while 63% screened for counts <100 cells/mm³ when newly initiating ART. The primary barriers reported were uncertainty about benefits (42%) and uncertainty about recommendations (32%). Most respondents (79%) reported they would perform lumbar puncture and order cerebrospinal fluid testing for positive CrAg screening results.

Conclusion

The survey reveals moderate adherence to national and international CrAg screening recommendations among infectious disease specialists. Significant opportunities exist for improving understanding and adherence to CrAg screening guidelines through targeted education about benefits and standardized recommendations.

Published in:Emerging Infectious Diseases,
Study Type:Survey,
Source: PMID: 40562736, DOI: 10.3201/eid3107.250295