Emerg Infect Dis. 2014 Jan;20(1):45-53. doi: 10.3201/eid2001.130906.
Cryptococcal meningitis is common in sub-Saharan Africa. Given the need for data for a rapid, point-of-care cryptococcal antigen (CRAG) lateral flow immunochromatographic assay (LFA), we assessed diagnostic performance of cerebrospinal fluid (CSF) culture, CRAG latex agglutination, India ink microscopy, and CRAG LFA for 832 HIV-infected persons with suspected meningitis during 2006-2009 (n = 299) in Uganda and during 2010-2012 (n = 533) in Uganda and South Africa. CRAG LFA had the best performance (sensitivity 99.3%, specificity 99.1%). Culture sensitivity was dependent on CSF volume (82.4% for 10 μL, 94.2% for 100 μL). CRAG latex agglutination test sensitivity (97.0%-97.8%) and specificity (85.9%-100%) varied between manufacturers. India ink microscopy was 86% sensitive. Laser thermal contrast had 92% accuracy (R = 0.91, p<0.001) in quantifying CRAG titers from 1 LFA strip to within <1.5 dilutions of actual CRAG titers. CRAG LFA is a major advance for meningitis diagnostics in resource-limited settings.
隐球菌性脑膜炎在撒哈拉以南非洲很常见。鉴于需要为快速、即时的 cryptococcal 抗原（CRAG）侧向流动免疫层析测定（LFA）提供数据，我们评估了脑脊液（CSF）培养、CRAG 乳胶凝集、印度墨水显微镜检查和 CRAG LFA 在 2006-2009 年（n = 299）和 2010-2012 年（n = 533）乌干达和南非 832 名疑似脑膜炎的 HIV 感染者中的诊断性能。CRAG LFA 的性能最佳（敏感性 99.3%，特异性 99.1%）。培养物的敏感性取决于 CSF 量（10 μL 时为 82.4%，100 μL 时为 94.2%）。CRAG 乳胶凝集试验的敏感性（97.0%-97.8%）和特异性（85.9%-100%）在不同制造商之间有所不同。印度墨水显微镜检查的敏感性为 86%。激光热对比度在定量 CRAG 滴度方面具有 92%的准确性（R = 0.91，p<0.001），从 1 个 LFA 条带内的 CRAG 滴度与实际 CRAG 滴度相差 <1.5 稀释度。CRAG LFA 是资源有限环境中脑膜炎诊断的重大进展。
