即时检验实验室检测时代的隐球菌性脑膜炎诊断和筛查。
Cryptococcal Meningitis Diagnostics and Screening in the Era of Point-of-Care Laboratory Testing.
机构信息
Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, Johanneseburg, South Africa.
出版信息
J Clin Microbiol. 2019 Jan 2;57(1). doi: 10.1128/JCM.01238-18. Print 2019 Jan.
Abstract
Over the past ten years, standard diagnostics for cryptococcal meningitis in HIV-infected persons have evolved from culture to India ink to detection of cryptococcal antigen (CrAg), with the recent development and distribution of a point-of-care lateral flow assay. This assay is highly sensitive and specific in cerebrospinal fluid (CSF), but is also sensitive in the blood to detect CrAg prior to meningitis symptoms. CrAg screening of HIV-infected persons in the blood prior to development of fulminant meningitis and preemptive treatment for CrAg-positive persons are recommended by the World Health Organization and many national HIV guidelines. Thus, CrAg testing is occurring more widely, especially in resource-limited laboratory settings. CrAg titer predicts meningitis and death and could be used in the future to customize therapy according to burden of infection.
摘要
在过去的十年中，HIV 感染者隐球菌性脑膜炎的标准诊断方法已经从培养、印度墨水检测发展到隐球菌抗原（CrAg）检测，最近还开发和分发了一种即时侧向流动检测。该检测在脑脊液（CSF）中具有很高的灵敏度和特异性，但在血液中也很敏感，可以在脑膜炎症状出现之前检测到 CrAg。世界卫生组织和许多国家的 HIV 指南建议，在爆发性脑膜炎发生之前对 HIV 感染者进行血液 CrAg 筛查，并对 CrAg 阳性者进行预防性治疗。因此，CrAg 检测的应用范围越来越广，尤其是在资源有限的实验室环境中。CrAg 滴度可预测脑膜炎和死亡，未来可能根据感染负担来定制治疗方案。
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