Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Jan 2;57(1):e01238-18.
doi: 10.1128/JCM.01238-18. Print 2019 Jan.

Cryptococcal Meningitis Diagnostics and Screening in the Era of Point-of-Care Laboratory Testing

Radha Rajasingham  1 , Rachel M Wake  2   3 , Tafese Beyene  4 , Andrew Katende  5 , Emilio Letang  5   6   7   8   9 , David R Boulware  10
Affiliations
Review

Cryptococcal Meningitis Diagnostics and Screening in the Era of Point-of-Care Laboratory Testing

Radha Rajasingham et al. J Clin Microbiol. .

Abstract

Over the past ten years, standard diagnostics for cryptococcal meningitis in HIV-infected persons have evolved from culture to India ink to detection of cryptococcal antigen (CrAg), with the recent development and distribution of a point-of-care lateral flow assay. This assay is highly sensitive and specific in cerebrospinal fluid (CSF), but is also sensitive in the blood to detect CrAg prior to meningitis symptoms. CrAg screening of HIV-infected persons in the blood prior to development of fulminant meningitis and preemptive treatment for CrAg-positive persons are recommended by the World Health Organization and many national HIV guidelines. Thus, CrAg testing is occurring more widely, especially in resource-limited laboratory settings. CrAg titer predicts meningitis and death and could be used in the future to customize therapy according to burden of infection.

Keywords: Cryptococcus; diagnostics; point-of-care; prevention.

PubMed Disclaimer

Figures

FIG 1
FIG 1
Venn diagram of distribution of CSF diagnostic testing in Uganda and South Africa during 2006 to 2012 (n = 832) (8).
FIG 2
FIG 2
Venn diagram of the distribution of positivity by blood CrAg, CSF CrAg, and CSF culture (16).
FIG 3
FIG 3
Survival by CrAg titer in 287 asymptomatic HIV-infected persons with cryptococcal antigenemia in four cohorts in Ethiopia, South Africa, Tanzania, and Uganda (26, 27, 29, 32).
See this image and copyright information in PMC

References

    1. Rajasingham R, Smith RM, Park BJ, Jarvis JN, Govender NP, Chiller TM, Denning DW, Loyse A, Boulware DR. 2017. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis 17:873–881. doi:10.1016/S1473-3099(17)30243-8. - DOI - PMC - PubMed
    1. Rhein J, Hullsiek KH, Evans EE, Tugume L, Nuwagira E, Ssebambulidde K, Kiggundu R, Mpoza E, Musubire AK, Bangdiwala AS, Bahr NC, Williams DA, Abassi M, Muzoora C, Meya DB, Boulware DR. 2018. Detrimental outcomes of unmasking cryptococcal meningitis with recent ART initiation. Open Forum Infect Dis 5:ofy122. doi:10.1093/ofid/ofy122. - DOI - PMC - PubMed
    1. Oladele RO, Bongomin F, Gago S, Denning DW. 2017. HIV-associated cryptococcal disease in resource-limited settings: a case for “prevention is better than cure”? J Fungi (Basel) 3:E67. doi:10.3390/jof3040067. - DOI - PMC - PubMed
    1. Butler EK, Boulware DR, Bohjanen PR, Meya DB. 2012. Long term 5-year survival of persons with cryptococcal meningitis or asymptomatic subclinical antigenemia in Uganda. PLoS One 7:e51291. doi:10.1371/journal.pone.0051291. - DOI - PMC - PubMed
    1. Dyal J, Akampurira A, Rhein J, Morawski BM, Kiggundu R, Nabeta HW, Musubire AK, Bahr NC, Williams DA, Bicanic T, Larsen RA, Meya DB, Boulware DR. 2016. Reproducibility of CSF quantitative culture methods for estimating rate of clearance in cryptococcal meningitis. Med Mycol 54:361–369. doi:10.1093/mmy/myv104. - DOI - PMC - PubMed

MeSH terms

Substances

LinkOut - more resources