Evaluation of five conventional and molecular approaches for diagnosis of cryptococcal meningitis in non-HIV-infected patients

Mycoses. 2016 Aug;59(8):494-502. doi: 10.1111/myc.12497. Epub 2016 Apr 8.

Abstract

Cryptococcal meningitis (CM) is a life-threatening mycosis primarily occurring in HIV-infected individuals. Recently, non-HIV-infected hosts were increasingly reported to form a considerable proportion. However, the majority of the reported studies on the diagnosis of CM patients were performed on HIV-infected patients. For evaluation of various diagnostic approaches for CM in non-HIV-infected patients, a range of conventional and molecular assays used for diagnosis of CM were verified on 85 clinical CSFs from non-HIV-infected CM patients, including India ink staining, culture, a newly developed loop-mediated isothermal amplification (LAMP), the lateral flow assay (LFA) of cryptococcal antigen detection and a qPCR assay. The LFA had the highest positive detection rate (97.6%; 95% CI, 91.8-99.7%) in non-HIV-infected CM patients, followed by the LAMP (87.1%; 95% CI, 78.0-93.4%), the qPCR (80.0%; 95% CI, 69.9-87.9%), India ink staining (70.6%; 95% CI, 59.7-80.0%) and culture (35.3%; 95% CI, 25.2-46.4%). All culture positive specimens were correctly identified by the LFA.

Keywords: Cryptococcal meningitis; Diagnosis; non-HIV-infected host.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use
  • Antigens, Fungal / analysis*
  • Antigens, Fungal / genetics
  • Carbon
  • Cryptococcus / genetics
  • Cryptococcus / growth & development
  • Cryptococcus / isolation & purification*
  • DNA, Fungal / isolation & purification
  • Female
  • Humans
  • Immunocompromised Host
  • Male
  • Meningitis, Cryptococcal / cerebrospinal fluid
  • Meningitis, Cryptococcal / diagnosis*
  • Meningitis, Cryptococcal / microbiology
  • Middle Aged
  • Molecular Diagnostic Techniques / methods*
  • Real-Time Polymerase Chain Reaction
  • Sensitivity and Specificity

Substances

  • Antifungal Agents
  • Antigens, Fungal
  • DNA, Fungal
  • chinese ink
  • Carbon

Associated data

  • GENBANK/2013SMMU-LL013
  • GENBANK/EF211264