Program Schedule

1791
Evaluating Cryptococcal Antigen Lateral Flow Assay by Fingerstick Whole Blood in HIV-Infected Persons with Meningitis

Session: Oral Abstract Session: Global Infectious Diseases
Saturday, October 11, 2014: 2:45 PM
Room: The Pennsylvania Convention Center: 111-AB
Background: Cryptococcal meningitis remains the most common cause of adult meningitis in sub-Saharan Africa and causes a significant burden of mortality in HIV-infected persons living with AIDS. The diagnosis of cryptococcal meningitis has been simplified by the Cryptococcal lateral flow assay (CRAG LFA). This point-of-care test is FDA-approved for use in serum or CSF. We evaluated the utility of the CRAG LFA using fingerstick whole blood (compared with serum and plasma) for meningitis screening and diagnostics.

Methods: From August 2013 until April 2014, CRAG LFA tests (IMMY, Norman, Oklahoma) were performed on fingerstick whole blood, plasma and/or serum in 179 HIV-infected adults who were admitted to Mulago National Referral hospital in Kampala, Uganda with symptoms of meningitis. A fingerstick CRAG LFA was performed (n=179). Venous blood was also collected and centrifuged to obtain serum and plasma (n=173). CSF was tested after lumbar puncture (n=189).

Results: Of the 173 meningitis patients with all specimen types tested, 127 (73%) were CRAG positive and 46 (27%) were CRAG negative. In 100% of 173 tests performed, there was agreement between fingerstick whole blood, serum, and plasma in both positive and negative results (Kappa=1.0, 95%CI lower margin: 0.979). Of the 129 patients who tested CRAG+ by fingerstick, 119 (92%) had cryptococcal meningitis with a positive CSF CRAG.  Ten (5.6%) had isolated cryptococcal antigenemia with a negative CSF CRAG. No persons with cryptococcal meningitis had a negative fingerstick.

Conclusion: The 100% agreement between whole blood, serum, and plasma CRAG LFA results demonstrate that fingerstick is a viable option for detecting CRAG, particularly in settings where phlebotomy is not available. Additionally, using fingerstick CRAG LFA allows healthcare centers to rapidly screen a large number of patients, and prioritize among whom to measure CSF opening pressure or empirically remove a large volume of CSF.

Darlisha Williams, MPH1,2, Kiiza Tadeo2, Sruti Velamakkani1, Reuben Kiggundu, MBChB2, David Meya, MMed1,2, Joshua Rhein, MD1,2 and David Boulware, MD, MPH1,3, (1)Center for Infectious Diseases & Microbiology Translational Research, University of Minnesota, Minneapolis, MN, (2)Infectious Disease Institute, Makerere University, Kampala, Uganda, (3)Infectious Disease and International Medicine, University of Minnesota, Minneapolis, MN

Disclosures:

D. Williams, None

K. Tadeo, None

S. Velamakkani, None

R. Kiggundu, None

D. Meya, None

J. Rhein, None

D. Boulware, None

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