Program Schedule

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


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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