title: Evaluation of fingerstick cryptococcal antigen lateral flow assay in HIV-infected persons: a diagnostic accuracy study.
abstract: BACKGROUND
  Cryptococcus neoformans is the most common cause of adult meningitis in sub-Saharan Africa. The cryptococcal antigen (CRAG) lateral flow assay (LFA) has simplified diagnosis as a point-of-care test approved for serum or cerebrospinal fluid (CSF). We evaluated the accuracy of the CRAG LFA using fingerstick whole blood compared with serum/plasma and CSF for diagnosing meningitis.
  
  
  METHODS
  From August 2013 to August 2014, CRAG LFA (IMMY, Norman, Oklahoma) tests were performed on fingerstick whole blood, plasma/serum, and CSF in 207 HIV-infected adults with suspected meningitis in Kampala, Uganda. Venous blood was also collected and centrifuged to obtain serum and/or plasma. CSF was tested after lumbar puncture.
  
  
  RESULTS
  Of 207 participants, 149 (72%) had fingerstick CRAG-positive results. There was 100% agreement between fingerstick whole blood and serum/plasma. Of the 149 fingerstick CRAG-positive participants, 138 (93%) had evidence of cryptococcal meningitis with a positive CSF CRAG. Eleven participants (5%) had isolated cryptococcal antigenemia with a negative CSF CRAG and culture, of whom 8 had CSF abnormalities (n = 3 lymphocytic pleocytosis, n = 5 elevated protein, n = 4 increased opening pressure). No persons with cryptococcal meningitis had negative fingersticks.
  
  
  CONCLUSIONS
  The 100% agreement between whole blood, serum, and plasma CRAG LFA results demonstrates that fingerstick CRAG is a reliable bedside diagnostic test. Using point-of-care CRAG testing simplifies screening large numbers of patients and enables physicians to prioritize on whom to measure CSF opening pressure using manometers.
authors.affiliation: University of Minnesota, Minneapolis Infectious Diseases Institute.
authors.forename: Darlisha A
authors.initials: DA
authors.lastname: Williams
authors.affiliation: Infectious Diseases Institute.
authors.forename: Tadeo
authors.initials: T
authors.lastname: Kiiza
authors.affiliation: Infectious Diseases Institute.
authors.forename: Richard
authors.initials: R
authors.lastname: Kwizera
authors.affiliation: Infectious Diseases Institute.
authors.forename: Reuben
authors.initials: R
authors.lastname: Kiggundu
authors.affiliation: University of Minnesota, Minneapolis.
authors.forename: Sruti
authors.initials: S
authors.lastname: Velamakanni
authors.affiliation: University of Minnesota, Minneapolis Infectious Diseases Institute College of Health Sciences, Department of Medicine, Makerere University, Kampala, Uganda.
authors.forename: David B
authors.initials: DB
authors.lastname: Meya
authors.affiliation: University of Minnesota, Minneapolis Infectious Diseases Institute.
authors.forename: Joshua
authors.initials: J
authors.lastname: Rhein
authors.affiliation: University of Minnesota, Minneapolis.
authors.forename: David R
authors.initials: DR
authors.lastname: Boulware
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000328:Adult; D000946:Antigens, Fungal / Q000097:blood* / Q000134:cerebrospinal fluid; D005260:Female; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis*; D009172:Mycology / Q000379:methods*; D019095:Point-of-Care Systems; D011446:Prospective Studies; D015203:Reproducibility of Results; D014454:Uganda
chemical_list: D000946:Antigens, Fungal
keywords: HIV; cryptococcal meningitis; cryptococcus; lateral flow assay; point-of-care systems
references.citation: N Engl J Med. 2014 Jun 26;370(26):2487-98
references.pmid: 24963568
references.citation: Clin Infect Dis. 2014 Dec 1;59(11):1607-14
references.pmid: 25057102
references.citation: Int J Infect Dis. 2007 Nov;11(6):524-30
references.pmid: 17512773
references.citation: J Acquir Immune Defic Syndr. 2014 Jun 1;66(2):e31-6
references.pmid: 24675586
references.citation: Clin Infect Dis. 2014 Jun;58(12):1771-7
references.pmid: 24668125
references.citation: AIDS. 2009 Mar 27;23(6):701-6
references.pmid: 19279443
references.citation: Clin Infect Dis. 2011 Nov;53(10):1019-23
references.pmid: 21940419
references.citation: PLoS One. 2014 Jul 31;9(7):e103156
references.pmid: 25078453
references.citation: AIDS. 2009 Feb 20;23(4):525-30
references.pmid: 19182676
references.citation: BMC Infect Dis. 2010 Mar 15;10:67
references.pmid: 20230635
references.citation: J Acquir Immune Defic Syndr. 2013 Jul 1;63(3):e101-8
references.pmid: 23466647
references.citation: Trop Med Int Health. 2010 Aug;15(8):910-7
references.pmid: 20573075
references.citation: Clin Infect Dis. 2010 Feb 1;50(3):291-322
references.pmid: 20047480
references.citation: Clin Infect Dis. 2007 Jul 1;45(1):76-80
references.pmid: 17554704
references.citation: AIDS. 2000 Jul 7;14(10):1401-7
references.pmid: 10930155
references.citation: Emerg Infect Dis. 2014 Jan;20(1):45-53
references.pmid: 24378231