Author(s): Boulware DR, Rolfes MA, Rajasingham R, von Hohenberg M, Qin Z,
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Abstract Cryptococcal meningitis is common in sub-Saharan Africa. Given the need for data for a rapid, point-of-care cryptococcal antigen (CRAG) lateral flow immunochromatographic assay (LFA), we assessed diagnostic performance of cerebrospinal fluid (CSF) culture, CRAG latex agglutination, India ink microscopy, and CRAG LFA for 832 HIV-infected persons with suspected meningitis during 2006-2009 (n = 299) in Uganda and during 2010-2012 (n = 533) in Uganda and South Africa. CRAG LFA had the best performance (sensitivity 99.3\%, specificity 99.1\%). Culture sensitivity was dependent on CSF volume (82.4\% for 10 μL, 94.2\% for 100 μL). CRAG latex agglutination test sensitivity (97.0\%-97.8\%) and specificity (85.9\%-100\%) varied between manufacturers. India ink microscopy was 86\% sensitive. Laser thermal contrast had 92\% accuracy (R = 0.91, p<0.001) in quantifying CRAG titers from 1 LFA strip to within <1.5 dilutions of actual CRAG titers. CRAG LFA is a major advance for meningitis diagnostics in resource-limited settings.
This article was published in Emerg Infect Dis
and referenced in Fungal Genomics & Biology