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对于既往未诊断为隐球菌感染的患者,通过侧流分析法测定的低隐球菌抗原滴度结果应谨慎解读。

Low Cryptococcus Antigen Titers as Determined by Lateral Flow Assay Should Be Interpreted Cautiously in Patients without Prior Diagnosis of Cryptococcal Infection.

作者信息

Dubbels Marie, Granger Dane, Theel Elitza S

机构信息

Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.

Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA

出版信息

J Clin Microbiol. 2017 Aug;55(8):2472-2479. doi: 10.1128/JCM.00751-17. Epub 2017 May 31.

Abstract

Detection of antigen (CrAg) is invaluable for establishing cryptococcal disease. Multiple different methods for CrAg detection are available, including a lateral flow assay (LFA). Despite excellent performance of the CrAg LFA, we have observed multiple cases of low-titer (≤1:5) positive CrAg LFA results in patients for whom cryptococcosis was ultimately excluded. To investigate the accuracy of low-titer positive CrAg LFA results, we performed chart reviews for all patients with positive CrAg LFA results between June 2014 and December 2016. During this period, serum and/or cerebrospinal fluid (CSF) samples from 3,969 patients were tested with the CrAg LFA, and 55 patients (1.5%) tested positive. Thirty-eight of those patients lacked a history of cryptococcal disease and were the focus of this study. Fungal culture or histopathology confirmed infection for 20 patients (52.6%), and CrAg LFA titers in serum and CSF samples ranged from 1:5 to ≥1:2,560. For the 18 patients (47.4%) without culture or histopathological confirmation, the CrAg LFA results were considered true-positive results for 5 patients (titer range, 1:10 to ≥1:2,560), due to clinical improvement with targeted therapy and decreasing CrAg LFA titers. The remaining 13 patients had CrAg LFA titers of 1:2 ( = 11) or 1:5 ( = 2) and were ultimately diagnosed with an alternative condition ( = 11) or began therapy for possible cryptococcosis without improvement ( = 2), leading to an overall CrAg LFA false-positive rate of 34%. We recommend careful clinical correlation prior to establishing a diagnosis of cryptococcal infection for patients with first-time positive CrAg LFA titers of 1:2.

摘要

检测隐球菌抗原(CrAg)对于确诊隐球菌病非常重要。目前有多种不同的CrAg检测方法,包括侧向流动分析法(LFA)。尽管CrAg LFA表现出色,但我们观察到多例CrAg LFA低滴度(≤1:5)阳性结果的患者,最终被排除患有隐球菌病。为了研究CrAg LFA低滴度阳性结果的准确性,我们对2014年6月至2016年12月期间所有CrAg LFA检测结果呈阳性的患者进行了病历回顾。在此期间,对3969例患者的血清和/或脑脊液(CSF)样本进行了CrAg LFA检测,其中55例(1.5%)检测呈阳性。这些患者中有38例没有隐球菌病病史,是本研究的重点。真菌培养或组织病理学证实20例患者(52.6%)感染,血清和脑脊液样本中的CrAg LFA滴度范围为1:5至≥1:2560。对于18例(47.4%)未通过培养或组织病理学确诊的患者,由于针对性治疗后临床症状改善且CrAg LFA滴度降低,5例患者(滴度范围为1:10至≥1:2560)的CrAg LFA结果被视为真阳性结果。其余13例患者的CrAg LFA滴度为1:2(n = 11)或1:5(n = 2),最终被诊断为其他疾病(n = 11)或开始接受可能的隐球菌病治疗但无改善(n = 2),导致CrAg LFA总体假阳性率为34%。对于首次CrAg LFA滴度为1:2呈阳性的患者,我们建议在诊断隐球菌感染之前进行仔细的临床关联分析。

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