{"doi":"10.1093/cid/ciac599","title":"Outpatient Cryptococcal Antigen Screening Is Associated With Favorable Baseline Characteristics and Improved Survival in Persons With Cryptococcal Meningitis in Uganda","abstract":"BACKGROUND: It is unknown whether persons with symptomatic cryptococcal meningitis detected during routine blood cryptococcal antigen (CrAg) screening have better survival than persons presenting with overt meningitis. METHODS: We prospectively enrolled Ugandans with HIV and cryptocococcal meningitis from December 2018 to December 2021. Participants were treated with amphotericin-based combination therapy. We compared outcomes between persons who were CrAg screened then referred to hospital with those presenting directly to the hospital with symptomatic meningitis. RESULTS: Among 489 participants with cryptococcal meningitis, 40% (194/489) received blood CrAg screening and were referred to hospital (median time to referral 2 days; interquartile range [IQR], 1-6). CrAg-screened persons referred to hospital had lower 14-day mortality than non-CrAg-screened persons who presented directly to hospital with symptomatic meningitis (12% vs 21%; hazard ratio, .51; 95% confidence interval, .32-.83; P = .006). Fewer CrAg-screened participants had altered mental status versus non-CrAg-screened participants (29% vs 41%; P = .03). CrAg-screened persons had lower quantitative cerebrospinal fluid (CSF) culture burden (median [IQR], 4570 [11-100 000] vs 26 900 [182-324 000] CFU/mL; P = .01) and lower CSF opening pressures (median [IQR], 190 [120-270] vs 225 [140-340] mmH2O; P = .004) compared with non-CrAg-screened persons. CONCLUSIONS: Survival from cryptococcal meningitis was higher in persons with prior CrAg screening than those without CrAg screening. Altered mental status was the most potent predictor for mortality in a multivariate model. We suggest that CrAg screening detects cryptococcal meningitis at an earlier stage, as evidenced by a favorable baseline risk profile and notably fewer persons with altered mental status.","journal":"Clinical Infectious Diseases","year":2022,"id":258870,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":17,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8045,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":267645,"name":"Ananta Bangdiwala","orcid":"0000-0003-0062-9434","position":1,"is_corresponding":false},{"id":910915,"name":"Elizabeth Nalintya","orcid":null,"position":2,"is_corresponding":false},{"id":498936,"name":"Enock Kagimu","orcid":"0000-0002-0291-651X","position":3,"is_corresponding":false},{"id":644484,"name":"John Kasibante","orcid":"0000-0002-7252-4052","position":4,"is_corresponding":false},{"id":644485,"name":"Morris K Rutakingirwa","orcid":"0000-0003-2276-360X","position":5,"is_corresponding":false},{"id":910489,"name":"Edward Mpoza","orcid":"0000-0001-8469-537X","position":6,"is_corresponding":false},{"id":910490,"name":"Samuel Jjunju","orcid":"0000-0003-4334-7111","position":7,"is_corresponding":false},{"id":292463,"name":"Edwin Nuwagira","orcid":"0000-0001-7526-9504","position":8,"is_corresponding":false},{"id":910916,"name":"Rose Naluyima","orcid":null,"position":9,"is_corresponding":false},{"id":910917,"name":"Paul Kirumira","orcid":null,"position":10,"is_corresponding":false},{"id":898,"name":"Cody R. Hou","orcid":"0000-0001-8692-6768","position":11,"is_corresponding":false},{"id":452980,"name":"Kenneth Ssebambulidde","orcid":"0000-0002-8125-0698","position":12,"is_corresponding":false},{"id":578702,"name":"Abdu K Musubire","orcid":"0000-0003-2410-5344","position":13,"is_corresponding":false},{"id":269371,"name":"Darlisha A Williams","orcid":null,"position":14,"is_corresponding":false},{"id":267660,"name":"Mahsa Abassi","orcid":"0000-0001-9601-3006","position":15,"is_corresponding":false},{"id":399943,"name":"Conrad Muzoora","orcid":"0000-0002-7866-5198","position":16,"is_corresponding":false},{"id":269372,"name":"Katherine Huppler Hullsiek","orcid":null,"position":17,"is_corresponding":false},{"id":267644,"name":"Radha Rajasingham","orcid":"0000-0001-5531-0231","position":18,"is_corresponding":false},{"id":397657,"name":"David B. Meya","orcid":"0000-0002-8854-0321","position":19,"is_corresponding":false},{"id":267658,"name":"David R. Boulware","orcid":"0000-0002-4715-0060","position":20,"is_corresponding":false},{"id":267647,"name":"Caleb P Skipper","orcid":"0000-0002-0000-8876","position":21,"is_corresponding":false},{"id":910914,"name":"Anna E Levin","orcid":null,"position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":null,"created_at":"2026-07-19T00:25:43.037820Z","pmid":"35859045","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}