title: Rapid diagnosis of cryptococcal meningitis by use of lateral flow assay on cerebrospinal fluid samples: influence of the high-dose "hook" effect.
abstract: 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.
authors.affiliation: Division of Medical Microbiology, Stellenbosch University, National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa adre.lourens@gmail.com.
authors.forename: Adré
authors.initials: A
authors.lastname: Lourens
authors.affiliation: Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom Botswana-University of Pennsylvania Partnership, Gaborone, Botswana University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Jarvis
authors.affiliation: Institute of Infectious Disease and Molecular Medicine and the Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Graeme
authors.initials: G
authors.lastname: Meintjes
authors.affiliation: Division of Medical Microbiology, Stellenbosch University, National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Samuel
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D000942:Antigens, Bacterial / Q000032:analysis*; D002555:Cerebrospinal Fluid / Q000737:chemistry*; D002648:Child; D002675:Child, Preschool; D002846:Chromatography, Affinity / Q000379:methods*; D005188:False Negative Reactions; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007223:Infant; D016919:Meningitis, Cryptococcal / Q000175:diagnosis*; D008853:Microscopy; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D000942:Antigens, Bacterial