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Volume 31, Number 7—July 2025
EIN Letter
Emerging Infections Network Survey of Screening for Cryptococcal Antigenemia, United States, 2024
Kaitlin Benedict
, Alexander Jordan, Jeremy A.W. Gold, Dallas J. Smith, Tom Chiller, Ian Hennessee, Philip M. Polgreen, and Susan E. Beekmann
, Alexander Jordan, Jeremy A.W. Gold, Dallas J. Smith, Tom Chiller, Ian Hennessee, Philip M. Polgreen, and Susan E. Beekmann
Table 1
Practice characteristics and testing practices reported by 215 US infectious disease providers in Emerging Infections Network survey of screening for cryptococcal antigenemia, United States, 2024 *
| Characteristic | Responses, no. (%)† |
|---|---|
| Primary practice setting | n = 214 |
| Community hospital | 48 (22) |
| Nonuniversity teaching hospital | 39 (18) |
| University hospital | 84 (39) |
| Veterans Affairs or Department of Defense hospital | 13 (6) |
| City, county, or public hospital | 10 (5) |
| Children’s hospital | 10 (5) |
| Cancer facility | 2 (1) |
| Outpatient only | 3 (1) |
| Other |
5 (2) |
| Respondent type | n = 212 |
| Infectious disease physician (primarily for adults) | 192 (91) |
| Infectious disease physician (primarily for children) | 14 (7) |
| Other |
3 (1) |
| Besides adult and adolescent patients with advanced HIV, do you think that other patient groups should be routinely screened for cryptococcal antigenemia? | n = 209 |
| Yes | 69 (33) |
| No | 84 (40) |
| Not sure |
56 (27) |
| Which barriers, if any, concern you or prevent you from obtaining CrAg testing for patients with HIV who are initiating or reinitiating ART and have a CD4 cell count <200 cells/mm3?‡ | n = 178 |
| Unsure of benefit of CrAg screening | 74 (42) |
| Uncertainty around CrAg screening recommendations | 57 (32) |
| Concern about delaying ART initiation or reinitiation | 18 (10) |
| Long turnaround time for send-out CrAg testing | 13 (7) |
| Difficulty of interpreting CrAg test results | 10 (6) |
| CrAg testing not available at my facility/institution | 4 (2) |
| Challenges with insurance coverage | 4 (2) |
| Other | 2 (1) |
| None of the choices |
74 (42) |
| Which of the following would you consider doing for a patient with a positive CrAg screening test result?‡ | n = 181 |
| Not applicable/I do not order CrAg testing | 7 (4) |
| Perform lumbar puncture and order cerebrospinal fluid testing for Cryptococcus or CrAg | 143 (79) |
| Evaluate for symptoms of meningitis | 140 (77) |
| Obtain CrAg titer | 124 (69) |
| Treatment with fluconazole while awaiting CSF results | 65 (36) |
| Other | 7 (4) |
| None of these | 1 (0.6) |
*ART, antiretroviral therapy; CrAg, cryptococcal antigen; CSF, cerebrospinal fluid; N, total number of responses. †Among respondents who answered each question. ‡Respondents could select all that apply.
Page created: May 15, 2025
Page updated: May 29, 2025
Page reviewed: May 29, 2025
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