High prevalence of cryptococcal infection among HIV-infected patients hospitalized with pneumonia in Thailand

Clin Infect Dis. 2012 Mar 1;54(5):e43-50. doi: 10.1093/cid/cir903. Epub 2011 Dec 23.


Background: Cryptococcal meningitis (CM) is a major cause of death among HIV-infected patients. Cryptococcal antigenemia (CrAg+) in the absence of CM can represent early-stage cryptococcosis during which antifungal treatment might improve outcomes. However, patients without meningitis are rarely tested for cryptococcal infection. We evaluated Cryptococcus species as a cause of acute respiratory infection in hospitalized patients in Thailand and evaluated clinical characteristics associated with CrAg+.

Methods: We tested banked serum samples from 704 human immunodeficiency virus (HIV)-infected and 730 HIV-uninfected patients hospitalized with acute respiratory infection from 2004 through 2009 in 2 rural provinces in Thailand for the presence of CrAg+. Retrospective chart reviews were conducted for CrAg+ patients to distinguish meningeal and nonmeningeal cryptococcosis and to identify clinical characteristics associated with CrAg+ in patients with and without evidence of CM.

Results: CrAg+ was found in 92 HIV-infected patients (13.1%); only tuberculosis (19.3%) and rhinovirus (16.5%) were identified more frequently. No HIV-uninfected patients were CrAg+. Of 70 CrAg+ patients with medical charts available, 37 (52.9%) had no evidence of past or existing CM at hospitalization; 30 of those patients (42.9% of all CrAg+) had neither past nor existing CM, nor any alternate etiology of infection identified. Dyspnea was more frequent among CrAg+ patients without CM than among CrAg- patients (P = .0002).

Conclusions: Cryptococcus species were the most common pathogens detected in HIV-infected patients hospitalized with acute respiratory infection in Thailand. Few clinical differences were found between antigenemic and nonantigenemic HIV-infected patients. Health care providers in Thailand should evaluate HIV-infected patients hospitalized with acute respiratory infection for cryptococcal antigenemia, even in the absence of meningitis.

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology
  • Adolescent
  • Adult
  • Aged
  • Antigens, Fungal / blood
  • Antigens, Fungal / immunology
  • Child
  • Child, Preschool
  • Cryptococcosis / complications
  • Cryptococcosis / diagnosis
  • Cryptococcosis / epidemiology*
  • Cryptococcus / immunology
  • Female
  • HIV Infections / complications*
  • Hospitalization*
  • Humans
  • Infant
  • Male
  • Meningitis, Cryptococcal / complications
  • Meningitis, Cryptococcal / epidemiology
  • Meningitis, Cryptococcal / microbiology
  • Middle Aged
  • Pneumonia / complications
  • Pneumonia / diagnosis
  • Pneumonia / epidemiology*
  • Prevalence
  • Risk Factors
  • Thailand / epidemiology
  • Young Adult


  • Antigens, Fungal