Cryptococcal meningitis: diagnostic value of cryptococcal antigen in cerebrospinal fluid

1975 ◽  
Vol 135 (9) ◽  
pp. 1155-1157 ◽  
Author(s):  
R. M. Snow
Keyword(s):  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Diagnostic Value ◽  
Cryptococcal Antigen

scholarly journals LATERAL FLOW ASSAY FOR CRYPTOCOCCAL ANTIGEN: AN IMPORTANT ADVANCE TO IMPROVE THE CONTINUUM OF HIV CARE AND REDUCE CRYPTOCOCCAL MENINGITIS-RELATED MORTALITY

2015 ◽  
Vol 57 (suppl 19) ◽  
pp. 38-45 ◽  
Author(s):  
Jose E. VIDAL ◽  
David R. BOULWARE
Keyword(s):  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Capsular Polysaccharide ◽  
Lateral Flow ◽  
Lateral Flow Assay ◽  
World Health ◽  
Hiv Care ◽  
Analytical Sensitivity ◽  
Symptomatic Infection ◽  
Cryptococcal Antigen

SUMMARYAIDS-related cryptococcal meningitis continues to cause a substantial burden of death in low and middle income countries. The diagnostic use for detection of cryptococcal capsular polysaccharide antigen (CrAg) in serum and cerebrospinal fluid by latex agglutination test (CrAg-latex) or enzyme-linked immunoassay (EIA) has been available for over decades. Better diagnostics in asymptomatic and symptomatic phases of cryptococcosis are key components to reduce mortality. Recently, the cryptococcal antigen lateral flow assay (CrAg LFA) was included in the armamentarium for diagnosis. Unlike the other tests, the CrAg LFA is a dipstick immunochromatographic assay, in a format similar to the home pregnancy test, and requires little or no lab infrastructure. This test meets all of the World Health Organization ASSURED criteria (Affordable, Sensitive, Specific, User friendly, Rapid/robust, Equipment-free, and Delivered). CrAg LFA in serum, plasma, whole blood, or cerebrospinal fluid is useful for the diagnosis of disease caused by Cryptococcusspecies. The CrAg LFA has better analytical sensitivity for C. gattii than CrAg-latex or EIA. Prevention of cryptococcal disease is new application of CrAg LFA via screening of blood for subclinical infection in asymptomatic HIV-infected persons with CD4 counts < 100 cells/mL who are not receiving effective antiretroviral therapy. CrAg screening of leftover plasma specimens after CD4 testing can identify persons with asymptomatic infection who urgently require pre-emptive fluconazole, who will otherwise progress to symptomatic infection and/or die.

scholarly journals Cryptococcal meningitis in apparently immunocompetent patients: association with idiopathic CD4+ lymphopenia

2017 ◽  
Vol 18 (2) ◽  
pp. 166-169 ◽  
Author(s):  
Samuel Shribman ◽  
Alastair Noyce ◽  
Sharmilee Gnanapavan ◽  
Jonathan Lambourne ◽  
Thomas Harrison ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Emergency Departments ◽  
Cryptococcal Antigen ◽  
Management Problems ◽  
Antigen Tests ◽  
Lymphocytic Meningitis ◽  
Immunocompetent Patients ◽  
Hiv Negative ◽  
New Onset

We present two cases of cryptococcal meningitis in people subsequently diagnosed with idiopathic CD4+ lymphopenia. Both presented with new onset headaches without sinister features and were sent home on multiple occasions from emergency departments. Cryptococcal meningitis in HIV-negative patients poses major diagnostic and management problems; the associated mortality is 9%–27%. We suggest performing blood and cerebrospinal fluid cryptococcal antigen tests in all people with lymphocytic meningitis.

scholarly journals Point-of-Care Diagnosis and Prognostication of Cryptococcal Meningitis With the Cryptococcal Antigen Lateral Flow Assay on Cerebrospinal Fluid

2013 ◽  
Vol 58 (1) ◽  
pp. 113-116 ◽  
Author(s):  
Taseera Kabanda ◽  
Mark J. Siedner ◽  
Jeffrey D. Klausner ◽  
Conrad Muzoora ◽  
David R. Boulware
Keyword(s):  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Point Of Care ◽  
Lateral Flow ◽  
Lateral Flow Assay ◽  
Cryptococcal Antigen

scholarly journals Cryptococcal Antigen in Serum and Cerebrospinal Fluid for Detecting Cryptococcal Meningitis in Adults Living With Human Immunodeficiency Virus: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies

2020 ◽  
Author(s):  
Elvis Temfack ◽  
Jean Joel Bigna Rim ◽  
Rene Spijker ◽  
Angela Loyse ◽  
Tom Chiller ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cerebrospinal Fluid ◽  
Sensitivity And Specificity ◽  
Antifungal Therapy ◽  
Cryptococcal Meningitis ◽  
Meta Analysis ◽  
Test Accuracy ◽  
Fungal Culture ◽  
Cryptococcal Antigen ◽  
Immunodeficiency Virus

Abstract Cryptococcal antigen (CrAg) detection could direct the timely initiation of antifungal therapy. We searched MEDLINE and Embase for studies where CrAg detection in serum/cerebrospinal fluid (CSF) and CSF fungal culture were done on adults living with human immunodeficiency virus (HIV) who had suspected cryptococcal meningitis (CM). With Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), we evaluated the risk of bias in 11 included studies with 3600 participants, and used a random-effects meta-analysis to obtain summary sensitivity and specificity of serum and CSF CrAg, as well as agreement between CSF CrAg and CSF culture. Summary sensitivity and specificity of serum CrAg were 99.7% (97.4–100) and 94.1% (88.3–98.1), respectively, and summary sensitivity and specificity of CSF CrAg were 98.8% (96.2–99.6) and 99.3% (96.7–99.9), respectively. Agreement between CSF CrAg and CSF culture was 98% (97–99). In adults living with HIV who have CM symptoms, serum CrAg negativity may rule out CM, while positivity should prompt induction antifungal therapy if lumbar puncture is not feasible. In a first episode of CM, CSF CrAg positivity is diagnostic.

scholarly journals Diagnostic Value of Latex Agglutination in Cryptococcal Meningitis

2009 ◽  
Vol 1 (02) ◽  
pp. 067-068 ◽  
Author(s):  
RM Saldanha Dominic ◽  
H V Prashanth ◽  
Shalini Shenoy ◽  
Shrikala Baliga
Keyword(s):  
Early Diagnosis ◽  
Cryptococcus Neoformans ◽  
Cryptococcal Meningitis ◽  
Diagnostic Value ◽  
Latex Agglutination ◽  
Antigen Detection ◽  
Specific Method ◽  
Cryptococcal Antigen ◽  
India Ink ◽  
Efficient Test

ABSTRACT Background: Cryptococcus neoformans is the most common fungal pathogen to infect the central nervous system, and an effective diagnostic method is therefore necessary for the early diagnosis of cryptococcal meningitis. Aim: The efficacy of India ink preparation, cerebrospinal fluid (CSF) culture and CSF cryptococcal antigen detection by the latex agglutination test for diagnosis of cryptococcal meningitis are compared to determine the most efficient test. Materials and Methods: Two hundred CSF samples from human immunodeficiency virus - positive patients suspected to be suffering from meningitis were screened for Cryptococcus neoformans. Results: Latex agglutination for cryptococcal antigen detection was found to be more sensitive compared to India ink staining and CSF culture. Conclusion: Antigen detection by latex agglutination proved to be both sensitive and specific method for the diagnosis of cryptococcal meningitis. Rapid, early diagnosis of infection by detection of cryptococcal antigen by latex agglutination may alter the prognosis for these patients.

scholarly journals Symptomatic Cryptococcal Meningitis with Negative Serum and Cerebrospinal Fluid Cryptococcal Antigen Tests

2021 ◽  
Vol Volume 13 ◽  
pp. 861-865
Author(s):  
Vivien Nanfuka ◽  
Mkhoi L Mkhoi ◽  
Jane Gakuru ◽  
Richard Kwizera ◽  
Joseph Baruch Baluku ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Cryptococcal Antigen ◽  
Antigen Tests

Evaluation of Clinical Profile, Diagnostic Tests, And Prognosis of Cryptococcal Meningitis in HIV Infected Patients in Western India

2020 ◽  
Vol 20 ◽  
Author(s):  
Deepak Kumar ◽  
Suresh Bishnoi ◽  
Durga Shankar Meena ◽  
Gopal Krishana Bohra ◽  
Naresh Midha ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Features ◽  
Cryptococcal Meningitis ◽  
Fatal Outcome ◽  
Clinical Profile ◽  
Western India ◽  
Antigen Test ◽  
Cryptococcal Antigen ◽  
India Ink ◽  
Csf Examination

Background: Cryptococcal meningitis is a dreaded complication in HIV infected patients. It was associated with high mortality and morbidity before the advent of Highly Active Anti-Retroviral Therapy. A study was planned in our institute to evaluate the clinical profile, laboratory findings, and prognostic factors for survival in these patients. Settings and Design: A prospective hospital-based observational study, conducted in the Department of Medicine at a tertiary care centre in western Rajasthan. Method and Material: HIV infected patients presenting with clinical features of meningitis, and positive CSF culture for Cryptococcus were included in our study. All cases underwent detailed clinical history, physical examinations and relevant laboratory investigations including CD4 count and CSF examination. Results: 48 HIV infected cryptococcal meningitis patients were analysed, and the most common presenting clinical features were headache (85.42%), and fever (72.92%), followed by neck stiffness (62.50%). CSF examination was also done for Cryptococcal Antigen test which was reactive in all cases (100%), and India ink staining was positive in 43 cases (89.58%). Significant fatal outcome was associated with patients presenting with altered sensorium, loss of consciousness, cranial nerve palsy and CD4 cell count of less than 100. Similarly, on laboratory and imaging diagnosis, cryptococcal antigen test (>3+reactive), fundus examination (papilloedema) and abnormal CT/MRI brain imaging were associated with poor survival. Conclusion: Cryptococcal meningitis is a potentially lethal infection in immunocompromised individuals and should be diagnosed early with high clinical suspicion as around 10% of the cases may not be detected on India ink staining and a large proportion (75%) of cases may have normal imaging at initial evaluation. Early diagnosis, watchful eye on prognostic factors and treatment is vital to improve outcome in these patients.

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