Evaluation of Fingerstick Cryptococcal Antigen Lateral Flow Assay in HIV-Infected Persons: A Diagnostic Accuracy Study: Figure 1.

Williams, Darlisha A; Kiiza, Tadeo K.; Kwizera, Richard; Kiggundu, Reuben; Velamakanni, Sruti; Meya, David B.; Rhein, Joshua; Boulware, David R.

doi:10.1093/cid/civ263

Cited by 90 publications

(96 citation statements)

References 17 publications

(27 reference statements)

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“…Available data about urine shows high sensitivity and specificity (JARVIS et al, 2011;PELFREY & BAUMAN, 2012). A recent study that reported 100% agreement between whole blood, serum and plasma LFA results demonstrated that fingerstick CrAg is a reliable bedside diagnostic test (WILLIAMS et al, 2015). Fingerstick LFA seems to be an important and simple tool for the diagnosis of cryptococcal meningitis.…”

Section: Diagnosis Of Cryptococcal Meningitismentioning

confidence: 99%

“…The role of lumbar puncture in asymptomatic CrAg+ patients is yet to be defined. Symptoms are not reliable for detection of dissemination to the central nervous system 42 (WILLIAMS et al, 2015). Asymptomatic persons may have CSF positivity, and symptomatic persons may have CSF abnormalities but no diagnostic evidence of Cryptococcus.…”

Section: Screening and Preemptive Treatment For Subclinical Cryptococmentioning

confidence: 99%

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Lateral Flow Assay for Cryptococcal Antigen: An Important Advance to Improve the Continuum of Hiv Care and Reduce Cryptococcal Meningitis-Related Mortality

Vidal

Boulware

2015

Rev. Inst. Med. trop. S. Paulo

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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, Equipmentfree, and Delivered). CrAg LFA in serum, plasma, whole blood, or cerebrospinal fluid is useful for the diagnosis of disease caused by Cryptococcus species. 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/µL 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.

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Section: Diagnosis Of Cryptococcal Meningitismentioning

confidence: 99%

Section: Screening and Preemptive Treatment For Subclinical Cryptococmentioning

confidence: 99%

Lateral Flow Assay for Cryptococcal Antigen: An Important Advance to Improve the Continuum of Hiv Care and Reduce Cryptococcal Meningitis-Related Mortality

Vidal

Boulware

2015

Rev. Inst. Med. trop. S. Paulo

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“…115 Recently, a lateral flow assay was approved for use in serum and CSF, with sensitivity and specificity of greater than 98% in both specimen types (including whole blood from finger stick samples) and sensitivity of 85% in urine. 116–123 The semiquantitative test offers many advantages over the other serologic methods, including rapid turnaround (approximately 15 minutes), minimal requirements for laboratory infrastructure, stability at room temperature, low cost, and wider capture of C gattii polysaccharides. 116 Combined with these advantages, the assay’s excellent performance across a broad range of clinical settings, including settings with low burden of HIV infection and high rates of C gattii infection, 100–104 make it an attractive option for point-of-care testing in both resource-available and resource-limited settings.…”

Section: Laboratory Diagnosismentioning

confidence: 99%

Cryptococcosis

Maziarz

Perfect

2016

Infectious Disease Clinics of North America

564

576

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“…Either 40 µL of blood or CSF can determine if cryptococcal disease is present within 10 minutes. 16 It is now feasible for quantitative CSF cultures at baseline to become the mainstay of assessing severity of disease so that appropriate treatment decisions can follow. Baseline CSF quantitative cultures can be readily assessed at 4–7 days after incubation.…”

Section: Discussionmentioning

confidence: 99%

Reproducibility of CSF quantitative culture methods for estimating rate of clearance in cryptococcal meningitis

et al. 2016

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Quantitative cerebrospinal fluid (CSF) cultures provide a measure of disease severity in cryptococcal meningitis. The fungal clearance rate by quantitative cultures has become a primary endpoint for phase II clinical trials. This study determined the inter-assay accuracy of three different quantitative culture methodologies. Among 91 participants with meningitis symptoms in Kampala, Uganda during Aug-Nov 2013, 305 CSF samples were prospectively collected from patients at multiple time points during treatment. Samples were simultaneously cultured by three methods: 1) St. George’s 100mcL input volume of CSF with five 1:10 serial dilutions, 2 AIDS Clinical Trials Group (ACTG) method using 1000, 100, 10mcL input volumes, and two 1:100 dilutions with 100 and 10 mcL input volume per dilution on seven agar plates; and 3) 10mcL calibrated loop of undiluted and 1:100 diluted CSF (loop). Quantitative culture values did not statistically differ between St. George-ACTG methods (P=0.09) but did for St. George-10mcL loop (P<0.001). Repeated measures pairwise correlation between any of the methods was high (r≥0.88). For detecting sterility, the ACTG-method had the highest negative predictive value of 97% (91% St. George, 60% loop), but the ACTG-method had occasional (~10%) difficulties in quantification due to colony clumping. For CSF clearance rate, St. George-ACTG methods did not differ overall (mean −0.05±0.07 log10CFU/mL/day; P=0.14) on a group level; however, individual-level clearance varied. The St. George and ACTG quantitative CSF culture methods produced comparable but not identical results. Quantitative cultures can inform treatment management strategies.

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Evaluation of Fingerstick Cryptococcal Antigen Lateral Flow Assay in HIV-Infected Persons: A Diagnostic Accuracy Study: Figure 1.

Abstract: When testing 207 people with suspected meningitis by fingerstick with the cryptococcal antigen (CRAG) lateral flow assay, there was 100% agreement with serum or plasma CRAG testing. In 5% of participants, fingerstick testing detected cryptococcal antigenemia in peripheral blood.

Cited by 90 publications

References 17 publications

Lateral Flow Assay for Cryptococcal Antigen: An Important Advance to Improve the Continuum of Hiv Care and Reduce Cryptococcal Meningitis-Related Mortality

Lateral Flow Assay for Cryptococcal Antigen: An Important Advance to Improve the Continuum of Hiv Care and Reduce Cryptococcal Meningitis-Related Mortality

Cryptococcosis

Reproducibility of CSF quantitative culture methods for estimating rate of clearance in cryptococcal meningitis

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