Rapid diagnosis of cryptococcal meningitis by use of lateral flow assay on cerebrospinal fluid samples: influence of the high-dose "hook" effect

J Clin Microbiol. 2014 Dec;52(12):4172-5. doi: 10.1128/JCM.01683-14. Epub 2014 Sep 17.

Abstract

Cryptococcal meningitis is the most frequent cause of meningitis and a major cause of mortality in HIV-infected adults in Africa. This study evaluated the performance of the lateral flow assay (LFA) on cerebrospinal fluid (CSF) samples for the diagnosis of cryptococcal meningitis against that of existing diagnostic tests. LFA performed on 465 undiluted CSF samples had a sensitivity of 91%. When the LFA was paired with Gram staining, a sensitivity of 100% was achieved after implementation of a dilution step for samples with negative LFA results and the presence of yeasts on microscopy. Microscopy is essential for preventing the reporting of false-negative results due to the high-dose "hook" effect.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Africa
  • Antigens, Bacterial / analysis*
  • Cerebrospinal Fluid / chemistry*
  • Child
  • Child, Preschool
  • Chromatography, Affinity / methods*
  • False Negative Reactions
  • HIV Infections / complications
  • Humans
  • Infant
  • Meningitis, Cryptococcal / diagnosis*
  • Microscopy
  • Middle Aged
  • Prospective Studies
  • Sensitivity and Specificity
  • Time Factors

Substances

  • Antigens, Bacterial