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Evaluation of a Cryptococcal Antigen Lateral Flow Assay and Cryptococcal Antigen Positivity at a Large Public Hospital in Atlanta, Georgia
- Source :
- Open Forum Infectious Diseases
- Publication Year :
- 2021
- Publisher :
- Oxford University Press, 2021.
-
Abstract
- Background Cryptococcus neoformans is a major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected persons worldwide, and there are scarce recent data on cryptococcal antigen (CrAg) positivity in the United States We sought to determine the frequency of cryptococcal disease and compare the performance of a CrAg lateral flow assay (LFA) versus latex agglutination (LA) test. Methods All patients from Grady Health System in Atlanta who had a serum or cerebrospinal fluid (CSF) sample sent for CrAg testing as part of clinical care from November 2017 to July 2018 were included. Percentage positivity and test agreement were calculated. Results Among 467 patients, 557 diagnostic tests were performed; 413 on serum and 144 on CSF. The mean age was 44 years, and most were male (69%) and had HIV (79%). Twenty-four (6.4%, 95% confidence interval [CI] = 4.1–9.4) patients were serum CrAg positive, and 8 (5.8%, 95% CI = 2.6–11.2) individuals tested positive for CSF CrAg. Although overall agreement between the LA and LFA was substantial to high for CSF (κ = 0.71, 95% CI = 0.51–0.91) and serum (κ = 0.93, 95% CI = 0.86–1.00), respectively, there were important discrepancies. Five patients had false-positive CSF LA tests that affected clinical care, and 4 patients had discordant serum tests. Conclusions We found a moderately high proportion of cryptococcal disease and important discrepancies between the LA test and LFA. Clinical implications of these findings include accurate detection of serum CrAg and averting unnecessary treatment of meningitis with costly medications associated with high rates of adverse events.<br />We sought to determine the proportion of cryptococcal antigen (CrAg) positivity and compare a CrAg lateral flow assay (LFA) versus latex agglutination test in Atlanta, GA. CrAg positivity was moderately high, and there were important discrepancies between diagnostic tests.
- Subjects :
- medicine.medical_specialty
030231 tropical medicine
Cryptococcus
Disease
Major Articles
03 medical and health sciences
0302 clinical medicine
Cerebrospinal fluid
Internal medicine
diagnostics
Medicine
030212 general & internal medicine
Adverse effect
Cryptococcus neoformans
biology
business.industry
HIV
meningitis
biology.organism_classification
medicine.disease
Confidence interval
Latex fixation test
Infectious Diseases
AcademicSubjects/MED00290
Oncology
business
Meningitis
Subjects
Details
- Language :
- English
- ISSN :
- 23288957
- Volume :
- 8
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Open Forum Infectious Diseases
- Accession number :
- edsair.doi.dedup.....fef3f75b36ddfc2704d9da6d00c9ed8f