Performance of cryptococcal antigen lateral flow assay in serum, cerebrospinal fluid, whole blood, and urine in HIV-infected patients with culture-proven cryptococcal meningitis admitted at a Brazilian referral center

• Published in: Revista do Instituto de Medicina Tropical de São Paulo
• Main Authors: José E. Vidal, Carolina Toniolo, Adriana Paulino, Arnaldo L. Colombo, Marilena dos Anjos Martins, Cristina da Silva Meira, Renata Guise Soares Azevedo, Vera Lucia Pereira-Chioccola, Hélio Rodrigues Gomes, Marcia dos Santos Lazera, Augusto C. Penalva de Oliveira, David R. Boulware
• Format: Article in Journal/Newspaper
• Language: English
• Published: Universidade de São Paulo (USP) 2018
• Subjects: Cryptococcal meningitis; Cryptococcosis; Diagnosis; Human immunodeficiency virus; Acquired immunodeficiency syndrome; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1590/s1678-9946201860001; https://doaj.org/article/6148cd00776b4013bc03915b74e4d075

ABSTRACT Cryptococcal meningitis is the most common cause of opportunistic meningitis in HIV-infected patients in Brazil and causes unacceptable high mortality rates. In this study, HIV-infected patients with a first episode of culture-proven cryptococcal meningitis in cerebrospinal fluid (CSF) were prospectively included in order to evaluate sensitivity of cryptococcal antigen (CrAg) lateral flow assay (LFA) in serum, CSF, whole blood (fingerstick), and fresh urine. In addition, HIV-infected patients with other neurological confirmed diseases were included in order to evaluate the specificity of CrAg LFA in serum. Twenty patients with cryptococcal meningitis were included and in 19 of them, CrAg LFA in CSF, serum, and whole blood were positive (95% sensitivity). In 18 patients, India ink test was positive in CSF (90% sensitivity), and in 16 cases, CrAg LFA was positive in urine (80% sensitivity). Thirty-six HIV-infected patients with other neurological diseases had negative results of CrAg LFA in serum (100% specificity). In conclusion, CrAg LFA in serum, CSF, and whole blood showed high sensitivity and specificity. Whole blood CrAg LFA seems to be a good and reliable strategy to improve AIDS-related cryptococcal meningitis diagnosis in Brazil.