title: Point-of-Care Testing for Cryptococcal Disease Among Hospitalized Human Immunodeficiency Virus-Infected Adults in Ethiopia.
abstract: In a cross-sectional study among hospitalized human immunodeficiency virus (HIV)-infected patients in Ethiopia, we sought to determine the rates and predictors of cryptococcal disease and evaluate the test performance of a recently introduced point-of-care test for Cryptococcus neoformans detection in various biological samples. We tested serum, urine, and fingerstick blood samples from each patient with a cryptococcal antigen lateral flow assay (CRAG LFA; Immuno Mycologic Inc., Norman, OK). Cerebrospinal fluid was collected at the discretion of the treating physician. Logistic regression was used to identify risk factors for a positive test result. Agreement between different sample types was also assessed. Among 198 hospitalized HIV-infected patients with a median CD4 count of 93 cells/mm3, 18 patients (9.1%) had a positive serum CRAG LFA. Of these, 16 (8.1%) had confirmed cryptococcal meningitis (CM), all of whom had a positive fingerstick blood LFA result. There was a very high agreement between CRAG LFA tests in serum and fingerstick blood samples (κ = 0.97, 95% confidence interval [CI] = 0.91-1.00); this was higher than that between serum and urine samples (κ = 0.76, 95% CI = 0.58-0.93). A CD4 count < 100 cells/mm3was significantly associated with a positive CRAG LFA. The absence of fever, headache, meningismus, and neck stiffness had a negative predictive value of 100% for CM. In addition to finding high rates of cryptococcal disease, our study demonstrated that the use of the LFA on fingerstick whole blood is less invasive, and an effective method for CM case finding among hospitalized patients with HIV.
authors.affiliation: Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. admasu.tenna@aau.edu.et ethan.bornstein@ucdenver.edu.
authors.forename: Admasu Tenna
authors.initials: AT
authors.lastname: Mamuye
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. admasu.tenna@aau.edu.et ethan.bornstein@ucdenver.edu.
authors.forename: Ethan
authors.initials: E
authors.lastname: Bornstein
authors.affiliation: Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Obsie
authors.initials: O
authors.lastname: Temesgen
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Blumberg
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Russell R
authors.initials: RR
authors.lastname: Kempker
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000821:virology; D000328:Adult; D000946:Antigens, Fungal / Q000097:blood*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003453:Cryptococcosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D003454:Cryptococcus / Q000276:immunology* / Q000302:isolation & purification; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D016015:Logistic Models; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications / Q000175:diagnosis / Q000382:microbiology; D000067716:Point-of-Care Testing; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D000946:Antigens, Fungal