Evaluation of a Novel Point-of-Care Cryptococcal Antigen Test on Serum, Plasma, and Urine From Patients With HIV-Associated Cryptococcal Meningitis

Jarvis, Joseph N; Percival, Ann; Bauman, Sean K.; Pelfrey, Joy M.; Meintjes, Graeme; Williams, GN; Longley, Nicky; Harrison, Thomas S.; Tr, Kozel

doi:10.1093/cid/cir613

Cited by 283 publications

(246 citation statements)

References 20 publications

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“…The lateral flow assay for cryptococcal antigenemia has been validated as a good diagnostic screening test for cryptococcosis and could be integrated into primary health care, to detect the disease in patients with CD4 counts below 100 cell/ uL pre-ART 36 . There is also need for intensified community mobilization and sensitization on diseases such as TB, cryptococcal meningitis and Kaposi's sarcoma to raise the index of suspicion among communities to enable early treatment seeking.…”

Section: Discussionmentioning

confidence: 99%

Causes and outcome of hospitalization among HIV-infected adults receiving antiretroviral therapy in Mulago hospital, Uganda

2014

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Background: Cohorts describing cause specific mortality in HIV-infected patients initiating antiretroviral therapy (ART) operate on an outpatient basis. Hospitalized patients represent the spectrum and burden of severe morbidity and mortality in patients on ART. Objective: To determine the causes and outcomes of hospitalization among adults receiving ART. Methods: A prospective cohort study. We enrolled 201 participants (50% female) with median (IQR) age and CD4 count of 34 (28-40) years and 91(29-211) cells/uL respectively. Results: The most frequent causes of hospitalization were tuberculosis (TB) (37, 18%), cryptococcal meningitis (22, 11%), zidovudine (AZT) -associated anemia (19, 10%), sepsis (10, 5%) and Kaposi's sarcoma (10, 5%). Forty two patients (21%) died: 10 (24%) had TB, 8 (19%) had cryptococcal meningitis and 5 (12%) had sepsis, 9 (21%) had undiagnosed neurological syndromes while 10 (24%) had other illnesses. Predictors of death included low Karnofsky performance score of < 40 (OR, 21.1; CI 1.43-31.6) and age >34 years (OR, 7.65; CI 1.09-53.8).Conclusions: Opportunistic infections, malignancy and AZT-associated anemia contributed to most hospitalizations and mortality. It is important to intensify prevention, screening, and treatment for these opportunistic diseases and early ART initiation in HIV-infected patients. Tenofovir-based regimens, unless contraindicated should be scaled up to replace AZTbased regimens as first line ART drugs. Africa Health Sciences 2013; 13(4): 977 -985 http://dx

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Section: Discussionmentioning

confidence: 99%

Causes and outcome of hospitalization among HIV-infected adults receiving antiretroviral therapy in Mulago hospital, Uganda

2014

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“…Early demonstration studies have shown that the LFA has a high level of agreement with conventional antigen tests when performed on urine and serum samples (16). The LFA has been FDA approved for use on CSF samples, but published data on the sensitivity and specificity compared to those of the CLAT and culture are limited (1,17).…”

Section: Ryptococcal Meningitis (Cm) Is a Frequent Hiv-related Oppomentioning

confidence: 99%

Rapid Diagnosis of Cryptococcal Meningitis by Use of Lateral Flow Assay on Cerebrospinal Fluid Samples: Influence of the High-Dose “Hook” Effect

et al. 2014

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e Cryptococcal meningitis is the most frequent cause of meningitis and a major cause of mortality in HIV-infected adults in Africa. This study evaluated the performance of the lateral flow assay (LFA) on cerebrospinal fluid (CSF) samples for the diagnosis of cryptococcal meningitis against that of existing diagnostic tests. LFA performed on 465 undiluted CSF samples had a sensitivity of 91%. When the LFA was paired with Gram staining, a sensitivity of 100% was achieved after implementation of a dilution step for samples with negative LFA results and the presence of yeasts on microscopy. Microscopy is essential for preventing the reporting of false-negative results due to the high-dose "hook" effect.

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“…The simple and inexpensive cryptococcal polysaccharide antigen (CRAG) test has excellent sensitivity and specificity for detection of CRAG in serum, plasma, and CSF (Jarvis et al 2011b). Cryptococcal antigenemia, indicating early dissemination from the lung, precedes symptomatic meningitis by weeks to months (French et al 2002), with reported prevalence in cohorts of HIV-infected patients with CD4 ,100 cells/mL ranging between 2% and 21% Jarvis et al 2011a).…”

Section: Prevent CM Unmasked By Art Using Crag Screening and Preemptimentioning

confidence: 99%

Treatment Principles for Candida and Cryptococcus

Whitney

Bicanic

2014

Cold Spring Harbor Perspectives in Medicine

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Evaluation of a Novel Point-of-Care Cryptococcal Antigen Test on Serum, Plasma, and Urine From Patients With HIV-Associated Cryptococcal Meningitis

Abstract: This novel dipstick test has the potential to markedly improve early diagnosis of CM in many settings, enabling testing of urine in patients presenting to health care facilities in which lumbar puncture, or even blood sampling, is not feasible.

Cited by 283 publications

References 20 publications

Causes and outcome of hospitalization among HIV-infected adults receiving antiretroviral therapy in Mulago hospital, Uganda

Causes and outcome of hospitalization among HIV-infected adults receiving antiretroviral therapy in Mulago hospital, Uganda

Rapid Diagnosis of Cryptococcal Meningitis by Use of Lateral Flow Assay on Cerebrospinal Fluid Samples: Influence of the High-Dose “Hook” Effect

Treatment Principles for Candida and Cryptococcus

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