Cryptococcal Antigen Test Revisited: Significance for Cryptococcal Meningitis Therapy Monitoring in a Tertiary Chinese Hospital
Open accessAbstract
For a total of 29 non-human immunodeficiency virus 1 cryptococcal meningitis cases, titer changes in the latex agglutination test before and after therapy were reviewed along with clinical manifestations, laboratory findings, and therapy regimens. The cryptococcal antigen titer decreased for every case after therapy and was correlated to fungal clearance as defined by fungus smear and/or culture. However, cryptococcal antigen can remain at low titers for long periods of time after therapy, even when fungus smears and/or cultures become negative.
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Cryptococcal antigen can remain positive for long periods of time after therapy, even when culture and smears are negative.
“It has been shown that cryptococcal antigen can remain positive for long periods of time after therapy, even when culture and smears are negative (40).”
From Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens (2016) · cites this paper as [40]
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- [8]8. Yin, C. Y., H. Z. Lu, and R. Z. Shi. 2001. Review of cryptococcal meningitis. J. New Med. 32: 752-754.
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“It has been shown that cryptococcal antigen can remain positive for long periods of time after therapy, even when culture and smears are negative (40).”
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“following initiation of therapy, even after routine fungal culture and smear results become negative (20).”
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ResultThe Role of Cryptococcal Antigen Assay in Diagnosis and Monitoring of Cryptococcal Meningitis
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Importance of Follow-Up Cerebrospinal Fluid Analysis in Cryptococcal Meningoencephalitis
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“Our results are in line with previous reports [22–25] and it was thus recommended that followup antigen titers are not useful as prognostic marker during therapy.”
Diagnostic Value of Latex Agglutination in Cryptococcal Meningitis
Dominic, R. S., Prashanth, H., Shenoy, S., & Baliga, S. (2009) · Journal of Laboratory Physicians · doi:10.4103/0974-2727.59702 · Cited by 29
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Fleischer, E., & Aronson, P. L. (2020) · Pediatric Emergency Care · doi:10.1097/pec.0000000000002180 · Cited by 28 · see citing works
“Additionally, studies have suggested the possibility that positive antigen results after initiation of therapy may indicate persistence of antigen and not actual detection of live organisms.(22,25,52) False-negative results for viruses may be due to specimens containing low viral loads(31) and to the lower ability of…”
ResultDiagnostic Testing in Central Nervous System Infection
Kanjilal, S., Cho, T. A., & Piantadosi, A. L. (2019) · Seminars in Neurology · doi:10.1055/s-0039-1688441 · Cited by 31 · see citing works
“62, 63 For patients in whom LP is not accessible or contraindicated, the World Health Organization (WHO) recommends substituting with a serum CrAg assessed on a lateral flow assay or a latex agglutination platform.”
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“Cryptococcal antigen detection is a highly specific and rapid test, and the antigen can remain detectable for several months after infection (Lu et al., 2005).”
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“The latex agglutination test has diagnostic and prognostic value, since progressive disease is usually accompanied by increasing antigen titers [30].”
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“Some studies have proposed that CrAg detection has limited significance for therapeutic monitoring, as dead cryptococcal cells continue to release CrAg, which may still be detectable even months after the patient has been successfully cured [177, 178].”
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“Indeed previous studies have demonstrated that CrAg may be detectable for extended periods of time following initiation of therapy, even after routine fungal culture and smear results become negative.[15] Therefore, it may be more clinically relevant to compare the results of the FilmArray ME panel to those of routine…”
ResultSIGNIFICANCE OF ANTIBODY DETECTION IN THE DIAGNOSIS OF CRYPTOCOCCAL MENINGITIS
Patil, S. A., Katyayani, S., & Arvind, N. (2012) · Journal of Immunoassay and Immunochemistry · doi:10.1080/15321819.2011.606862 · Cited by 8 · see citing works
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A Rare Case of Cryptococcal Meningitis in a Child with a Congenital Heart Disease
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COVID-19, HIV, and Cryptococcal Meningitis Coinfections with Abnormal Laboratory Findings
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A Prospective Cohort Study of Cryptococcal Meningitis in Hiv Patients in a Tertiary Care Hospital
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Cryptococcal meningitis in Lubumbashi, DR Congo: Clinical Expressions and Diagnostic Procedures
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“However, its significance for therapeutic monitoring is limited [3].”
Background
- Authors
- Lu, H., Zhou, Y., Yin, Y., Pan, X., & Weng, X.
- Affiliations
- Shanghai Medical College of Fudan University (CN)
- Department of Infectious Diseases, Fudan University Huashan Hospital, Shanghai 200040
- ORCID
- Zhou, Yingjie
- Venue
- Journal of Clinical Microbiology
- Publisher
- American Society for Microbiology
- Published
- 2005-06
- Volume
- 43
- Issue
- 6
- Pages
- 2989-2990
- ISSN
- 0095-1137 (ISSN-L)
- 1098-660X
- PMC
- PMC1151949
- OpenAlex
- W2055535613
- Cited by
- 63
- References
- 0
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 3 · 2021: 5 · 2020: 3 · 2019: 4 · 2018: 5 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 3 · 2013: 3 · 2012: 2
- FWCI
- 2.63
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Clinical Microbiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Keywords
- cryptococcal meningitis, cryptococcal antigen test, latex agglutination test, treatment monitoring, fungal clearance, antifungal therapy, Cryptococcus neoformans
- MeSH terms
- Adolescent, Adult, Antifungal Agents, Antigens, Fungal, Child, China, Cryptococcus, Culture Media, Female, Hospitals, University, Humans, Latex Fixation Tests, Male, Middle Aged, Meningitis, Cryptococcal
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