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

Summary

Researchers surveyed infectious disease doctors across the United States about their use of a simple blood test that detects cryptococcal fungal infections in HIV patients before symptoms appear. The test, called cryptococcal antigen (CrAg) screening, can prevent serious illness and death if caught early, but the survey found that many doctors are not using it consistently. About 42% of doctors were unsure about the benefits of the test, and another 32% were confused about current screening recommendations, revealing a need for better education about this important preventive tool.

Background

Cryptococcosis is a severe fungal disease caused by Cryptococcus, with an estimated 3.4-6.5 cases per 100,000 population annually in the United States, primarily affecting immunosuppressed individuals. Cryptococcal antigen (CrAg) testing is a simple, rapid, and highly accurate diagnostic method that 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, yet limited data exist about actual CrAg screening practices in the United States.

Objective

To assess the prevalence and patterns of cryptococcal antigen screening practices among infectious disease specialists in the United States and identify potential barriers to implementation of screening recommendations.

Results

Of 215 respondents, 63% reported typically obtaining CrAg screening for patients with CD4 counts <100 cells/mm³ newly initiating antiretroviral therapy, while only 33% did so for CD4 <200 cells/mm³. Primary barriers to screening included uncertainty about benefits (42%) and uncertainty about recommendations (32%). When managing positive tests, 79% of respondents reported performing lumbar puncture and cerebrospinal fluid testing, and 77% evaluated for meningitis symptoms.

Conclusion

The survey reveals moderate adherence to CrAg screening guidelines among infectious disease providers, with significant uncertainty about screening benefits and recommendations representing key barriers to implementation. The findings identify opportunities for improved education and increased screening practices among infectious disease specialists.
  • Published in:Emerging Infectious Diseases,
  • Study Type:Survey,
  • Source: PMID: 40562736, DOI: 10.3201/eid3107.250295
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