Point of Care Testing for the Diagnosis of Fungal Infections: Are We There Yet?

Prattes, Juergen; Heldt, Sven; Eigl, Susanne; Hoenigl, Martin

doi:10.1007/s12281-016-0254-5

Cited by 38 publications

(31 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the invasive procedures necessary to collect preferred specimens (e.g., lung tissue) for histopathology are often contraindicated for severely ill patients (7). Direct microscopy, particularly of cerebrospinal fluid (CSF), is also routinely performed but is hampered by low sensitivity, primarily for patients with low fungal burdens (8). Due to these limitations, detection of Cryptococcus antigen (CrAg) in serum and CSF samples has emerged as an invaluable tool for the diagnosis of cryptococcal disease.…”

mentioning

confidence: 99%

Low Cryptococcus Antigen Titers as Determined by Lateral Flow Assay Should Be Interpreted Cautiously in Patients without Prior Diagnosis of Cryptococcal Infection

2017

View full text Add to dashboard Cite

Detection of Cryptococcus antigen (CrAg) is invaluable for establishing cryptococcal disease. Multiple different methods for CrAg detection are available, including a lateral flow assay (LFA). Despite excellent performance of the CrAg LFA, we have observed multiple cases of low-titer (Յ1:5) positive CrAg LFA results in patients for whom cryptococcosis was ultimately excluded. To investigate the accuracy of low-titer positive CrAg LFA results, we performed chart reviews for all patients with positive CrAg LFA results between June 2014 and December 2016. During this period, serum and/or cerebrospinal fluid (CSF) samples from 3,969 patients were tested with the CrAg LFA, and 55 patients (1.5%) tested positive. Thirty-eight of those patients lacked a history of cryptococcal disease and were the focus of this study. Fungal culture or histopathology confirmed Cryptococcus infection for 20 patients (52.6%), and CrAg LFA titers in serum and CSF samples ranged from 1:5 to Ն1:2,560. For the 18 patients (47.4%) without culture or histopathological confirmation, the CrAg LFA results were considered true-positive results for 5 patients (titer range, 1:10 to Ն1:2,560), due to clinical improvement with targeted therapy and decreasing CrAg LFA titers. The remaining 13 patients had CrAg LFA titers of 1:2 (n ϭ 11) or 1:5 (n ϭ 2) and were ultimately diagnosed with an alternative condition (n ϭ 11) or began therapy for possible cryptococcosis without improvement (n ϭ 2), leading to an overall CrAg LFA false-positive rate of 34%. We recommend careful clinical correlation prior to establishing a diagnosis of cryptococcal infection for patients with first-time positive CrAg LFA titers of 1:2.

show abstract

mentioning

confidence: 99%

Low Cryptococcus Antigen Titers as Determined by Lateral Flow Assay Should Be Interpreted Cautiously in Patients without Prior Diagnosis of Cryptococcal Infection

2017

View full text Add to dashboard Cite

show abstract

“…Currently, the WHO recommends routine screening in serum or plasma of HIV positive patients with less than 100 CD4 T cells/µL, which allows timely initiation of appropriate antifungal treatment and reduce the risk of complications and mortality in these patients [41]. This type of point-of-care (POC) assays are easy to perform, affordable, rapid (results in less than an hour), and have the potential to significantly improve the early diagnosis of cryptococcosis [42].…”

Section: Discussionmentioning

confidence: 99%

Frequency of Invasive Fungal Disease in Adults: Experience of a Specialized Laboratory in Medellín, Colombia (2009–2015)

Valencia

Cáceres

Bedout

et al. 2020

JoF

View full text Add to dashboard Cite

Invasive fungal diseases (IFD) contribute significantly to worldwide morbidity and mortality, but their frequency is not well-described in some countries. The present work describes the frequency of IFD in a specialized laboratory in Colombia. A retrospective, descriptive study was implemented between March 2009 and December 2015. Results: 13,071 patients with clinical suspicion of IFD were referred during the study period, from which 33,516 biological samples were processed and analyzed using 14 laboratory methods. Diagnosis was confirmed in 1425 patients (11%), distributed according to the mycoses of interest analyzed here: histoplasmosis in 641/11,756 patients (6%), aspergillosis in 331/10,985 patients (3%), cryptococcosis in 239/8172 patients (3%), pneumocystosis in 111/1651 patients (7%), paracoccidioidomycosis in 60/10,178 patients (0.6%), and invasive candidiasis in 48/7525 patients (0.6%). From the first year of the study period to the last year, there was a 53% increase in the number of cases of IFD diagnosed. Our laboratory experienced a high frequency of IFD diagnosis, possibly attributable to the availability of a greater range of diagnostic tools. Frequency of IFD in this study was atypical compared with other studies, probably as a result of the single laboratory-site analysis. This demonstrates that implementing educational strategies helps to create a high index of clinical suspicion, while the availability and utilization of appropriate diagnostic assays assure greater reliability in identification of these cases.

show abstract

“…Both LFD and PLA with a convincing clinical performance are developed using murine monoclonal antibody JF5 to detect an Aspergillus ‐specific extracellular glycoprotein antigen which is secreted during active growth of Aspergillus species 57,58 . Besides the reported high sensitivity and specificity, LFD and PLA have additional advantages such as low cost, minimal requirement of training, no need for specially equipped laboratories, rare cross‐reactivity with other fungal species (with the exception of Penicillium species) and compatible with either serum or BALF samples 59 …”

Section: Challenges and Prospectsmentioning

confidence: 99%

Cell wall polysaccharides from pathogenic fungi for diagnosis of fungal infectious disease

Osibe

Lei

Wang

et al. 2020

Mycoses

View full text Add to dashboard Cite

Invasive fungal diseases are associated with significant morbidity and mortality, particularly in immunocompromised individuals. Early and accurate diagnosis is crucial for effective treatment. Despite traditional methods such as microbiological culture, histopathology, radiology and direct microscopy are available, antigen/antibody‐based diagnostics are emerging for diagnosis of invasive fungal infections (IFI). Fungal cell wall is a unique structure composed of polysaccharides that are well correlated with fungal burden during fungal infections. Based on this feature, cell wall polysaccharides have been explored as antigens in IFIs diagnostics such as the galactomannan assay, mannan test, β‐glucan assay and cryptococcal CrAg test. Herein, we provide an overview on the cell wall polysaccharides from three opportunistic pathogens: Aspergillus fumigatus, Candida albicans and Cryptococcus neoformans, and their applications for IFIs diagnosis. The clinical outcome of newly developed cell wall polysaccharides‐based diagnostics is also discussed.

show abstract

Point of Care Testing for the Diagnosis of Fungal Infections: Are We There Yet?

Cited by 38 publications

References 63 publications

Low Cryptococcus Antigen Titers as Determined by Lateral Flow Assay Should Be Interpreted Cautiously in Patients without Prior Diagnosis of Cryptococcal Infection

Low Cryptococcus Antigen Titers as Determined by Lateral Flow Assay Should Be Interpreted Cautiously in Patients without Prior Diagnosis of Cryptococcal Infection

Frequency of Invasive Fungal Disease in Adults: Experience of a Specialized Laboratory in Medellín, Colombia (2009–2015)

Cell wall polysaccharides from pathogenic fungi for diagnosis of fungal infectious disease

Contact Info

Product

Resources

About