Evaluation of low cryptococcal antigen titer as determined by the lateral flow assay in serum and cerebrospinal fluid among HIV-negative patients: a retrospective diagnostic accuracy study
Abstract Cryptococcosis is one of the most common opportunistic infections in both immunocompetent and immunocompromised hosts. Although the cryptococcal antigen (CrAg) lateral flow assay (LFA) has been widely used in clinical settings due to its high sensitivity and specificity, the diagnostic valu...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-03-01
|
| Series: | IMA Fungus |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s43008-020-00028-w |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832569391601942528 |
|---|---|
| author | Xuan Wang Jia-Hui Cheng Ling-Hong Zhou Jun-Hao Zhu Rui-Ying Wang Hua-Zhen Zhao Ying-Kui Jiang Li-Ping Huang Ching-Wan Yip Chun-Xing Que Min Zhu Li-Ping Zhu |
| author_facet | Xuan Wang Jia-Hui Cheng Ling-Hong Zhou Jun-Hao Zhu Rui-Ying Wang Hua-Zhen Zhao Ying-Kui Jiang Li-Ping Huang Ching-Wan Yip Chun-Xing Que Min Zhu Li-Ping Zhu |
| author_sort | Xuan Wang |
| collection | DOAJ |
| description | Abstract Cryptococcosis is one of the most common opportunistic infections in both immunocompetent and immunocompromised hosts. Although the cryptococcal antigen (CrAg) lateral flow assay (LFA) has been widely used in clinical settings due to its high sensitivity and specificity, the diagnostic value of a low CrAg LFA titers remains unclear. In this study, we performed a retrospective analysis of 149 HIV-negative patients with low CrAg LFA titers (≤1:10) in a Chinese tertiary hospital from January 2013 to December 2017, to evaluate the diagnostic value of low CrAg LFA titers in serum and cerebrospinal fluid (CSF) at different thresholds. Sensitivity and specificity of low CrAg LFA titers in patients with definitive diagnoses of cryptococcosis were 39.6% (95% CI, 29.7–50.1%) and 100% (95% CI, 69.2–100%), respectively, at a threshold of 1:10 in serum. A sensitivity of 72.9% (95% CI, 62.9–81.5%) and a decreased specificity of 70.0% (95% CI, 34.8–93.3%) were observed at a threshold of 1:5 in serum. No false-positive cases were identified in patients with low CrAg titers in CSF and all positive predictive values (PPVs) were 100%. Among the cases with low serum CrAg titers, lumbar puncture was performed in 97 patients and positive CSF CrAg titers were reported in 6 patients. In conclusion, the results of this study imply that low CrAg LFA titer, either in serum or CSF, is crucial for early diagnosis of cryptococcosis in HIV-negative patients, and lumbar puncture is recommended to be performed routinely for CSF testing when a positive low serum titer is reported. Cryptococcal meningitis should be considered seriously when the CSF CrAg titer is positive. |
| format | Article |
| id | doaj-art-6084f9336506474d83cfd591a6fcfebd |
| institution | Kabale University |
| issn | 2210-6359 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | IMA Fungus |
| spelling | doaj-art-6084f9336506474d83cfd591a6fcfebd2025-02-02T21:34:35ZengBMCIMA Fungus2210-63592020-03-011111710.1186/s43008-020-00028-wEvaluation of low cryptococcal antigen titer as determined by the lateral flow assay in serum and cerebrospinal fluid among HIV-negative patients: a retrospective diagnostic accuracy studyXuan Wang0Jia-Hui Cheng1Ling-Hong Zhou2Jun-Hao Zhu3Rui-Ying Wang4Hua-Zhen Zhao5Ying-Kui Jiang6Li-Ping Huang7Ching-Wan Yip8Chun-Xing Que9Min Zhu10Li-Ping Zhu11Department of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan UniversityDepartment of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan UniversityDepartment of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan UniversityDivision of Mycology, Huashan Hospital, Shanghai Medical College, Fudan UniversityDepartment of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan UniversityDepartment of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan UniversityDepartment of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan UniversityDepartment of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan UniversityDepartment of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan UniversityDepartment of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan UniversityDivision of Mycology, Huashan Hospital, Shanghai Medical College, Fudan UniversityDepartment of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan UniversityAbstract Cryptococcosis is one of the most common opportunistic infections in both immunocompetent and immunocompromised hosts. Although the cryptococcal antigen (CrAg) lateral flow assay (LFA) has been widely used in clinical settings due to its high sensitivity and specificity, the diagnostic value of a low CrAg LFA titers remains unclear. In this study, we performed a retrospective analysis of 149 HIV-negative patients with low CrAg LFA titers (≤1:10) in a Chinese tertiary hospital from January 2013 to December 2017, to evaluate the diagnostic value of low CrAg LFA titers in serum and cerebrospinal fluid (CSF) at different thresholds. Sensitivity and specificity of low CrAg LFA titers in patients with definitive diagnoses of cryptococcosis were 39.6% (95% CI, 29.7–50.1%) and 100% (95% CI, 69.2–100%), respectively, at a threshold of 1:10 in serum. A sensitivity of 72.9% (95% CI, 62.9–81.5%) and a decreased specificity of 70.0% (95% CI, 34.8–93.3%) were observed at a threshold of 1:5 in serum. No false-positive cases were identified in patients with low CrAg titers in CSF and all positive predictive values (PPVs) were 100%. Among the cases with low serum CrAg titers, lumbar puncture was performed in 97 patients and positive CSF CrAg titers were reported in 6 patients. In conclusion, the results of this study imply that low CrAg LFA titer, either in serum or CSF, is crucial for early diagnosis of cryptococcosis in HIV-negative patients, and lumbar puncture is recommended to be performed routinely for CSF testing when a positive low serum titer is reported. Cryptococcal meningitis should be considered seriously when the CSF CrAg titer is positive.http://link.springer.com/article/10.1186/s43008-020-00028-wCryptococcosisMeningitisLow cryptococcal antigen titerLateral flow assayDiagnostic accuracy |
| spellingShingle | Xuan Wang Jia-Hui Cheng Ling-Hong Zhou Jun-Hao Zhu Rui-Ying Wang Hua-Zhen Zhao Ying-Kui Jiang Li-Ping Huang Ching-Wan Yip Chun-Xing Que Min Zhu Li-Ping Zhu Evaluation of low cryptococcal antigen titer as determined by the lateral flow assay in serum and cerebrospinal fluid among HIV-negative patients: a retrospective diagnostic accuracy study IMA Fungus Cryptococcosis Meningitis Low cryptococcal antigen titer Lateral flow assay Diagnostic accuracy |
| title | Evaluation of low cryptococcal antigen titer as determined by the lateral flow assay in serum and cerebrospinal fluid among HIV-negative patients: a retrospective diagnostic accuracy study |
| title_full | Evaluation of low cryptococcal antigen titer as determined by the lateral flow assay in serum and cerebrospinal fluid among HIV-negative patients: a retrospective diagnostic accuracy study |
| title_fullStr | Evaluation of low cryptococcal antigen titer as determined by the lateral flow assay in serum and cerebrospinal fluid among HIV-negative patients: a retrospective diagnostic accuracy study |
| title_full_unstemmed | Evaluation of low cryptococcal antigen titer as determined by the lateral flow assay in serum and cerebrospinal fluid among HIV-negative patients: a retrospective diagnostic accuracy study |
| title_short | Evaluation of low cryptococcal antigen titer as determined by the lateral flow assay in serum and cerebrospinal fluid among HIV-negative patients: a retrospective diagnostic accuracy study |
| title_sort | evaluation of low cryptococcal antigen titer as determined by the lateral flow assay in serum and cerebrospinal fluid among hiv negative patients a retrospective diagnostic accuracy study |
| topic | Cryptococcosis Meningitis Low cryptococcal antigen titer Lateral flow assay Diagnostic accuracy |
| url | http://link.springer.com/article/10.1186/s43008-020-00028-w |
| work_keys_str_mv | AT xuanwang evaluationoflowcryptococcalantigentiterasdeterminedbythelateralflowassayinserumandcerebrospinalfluidamonghivnegativepatientsaretrospectivediagnosticaccuracystudy AT jiahuicheng evaluationoflowcryptococcalantigentiterasdeterminedbythelateralflowassayinserumandcerebrospinalfluidamonghivnegativepatientsaretrospectivediagnosticaccuracystudy AT linghongzhou evaluationoflowcryptococcalantigentiterasdeterminedbythelateralflowassayinserumandcerebrospinalfluidamonghivnegativepatientsaretrospectivediagnosticaccuracystudy AT junhaozhu evaluationoflowcryptococcalantigentiterasdeterminedbythelateralflowassayinserumandcerebrospinalfluidamonghivnegativepatientsaretrospectivediagnosticaccuracystudy AT ruiyingwang evaluationoflowcryptococcalantigentiterasdeterminedbythelateralflowassayinserumandcerebrospinalfluidamonghivnegativepatientsaretrospectivediagnosticaccuracystudy AT huazhenzhao evaluationoflowcryptococcalantigentiterasdeterminedbythelateralflowassayinserumandcerebrospinalfluidamonghivnegativepatientsaretrospectivediagnosticaccuracystudy AT yingkuijiang evaluationoflowcryptococcalantigentiterasdeterminedbythelateralflowassayinserumandcerebrospinalfluidamonghivnegativepatientsaretrospectivediagnosticaccuracystudy AT lipinghuang evaluationoflowcryptococcalantigentiterasdeterminedbythelateralflowassayinserumandcerebrospinalfluidamonghivnegativepatientsaretrospectivediagnosticaccuracystudy AT chingwanyip evaluationoflowcryptococcalantigentiterasdeterminedbythelateralflowassayinserumandcerebrospinalfluidamonghivnegativepatientsaretrospectivediagnosticaccuracystudy AT chunxingque evaluationoflowcryptococcalantigentiterasdeterminedbythelateralflowassayinserumandcerebrospinalfluidamonghivnegativepatientsaretrospectivediagnosticaccuracystudy AT minzhu evaluationoflowcryptococcalantigentiterasdeterminedbythelateralflowassayinserumandcerebrospinalfluidamonghivnegativepatientsaretrospectivediagnosticaccuracystudy AT lipingzhu evaluationoflowcryptococcalantigentiterasdeterminedbythelateralflowassayinserumandcerebrospinalfluidamonghivnegativepatientsaretrospectivediagnosticaccuracystudy |