Chen Wen-Yu, Zhong Cheng, Zhou Jian-Ying, Zhou Hua
Department of Respiratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 314000, Zhejiang Province, China.
Department of Respiratory, The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
World J Clin Cases. 2023 Mar 16;11(8):1837-1846. doi: 10.12998/wjcc.v11.i8.1837.
At present, with the development of technology, the detection of cryptococcal antigen (CRAG) plays an increasingly important role in the diagnosis of cryptococcosis. However, the three major CRAG detection technologies, latex agglutination test (LA), lateral flow assay (LFA) and Enzyme-linked Immunosorbent Assay, have certain limitations. Although these techniques do not often lead to false-positive results, once this result occurs in a particular group of patients (such as human immunodeficiency virus patients), it might lead to severe consequences.
In the three cases we reported, we found that insufficient dilution of the samples may lead to false-positive results in the detection of cryptococcal capsule antigen, which has never been reported before.
Therefore, once the test results are inconsistent with the clinical symptoms, it is necessary to reexamine the samples carefully. Especially for LFA and LA, the samples can be fully diluted or segmented diluted to avoid false-positive results. It is certain that in the diagnosis, fluid and tissue culture should also be improved, combined with imaging, ink staining, and other methods to improve the accuracy of the diagnosis further.
目前，随着技术的发展，隐球菌抗原（CRAG）检测在隐球菌病的诊断中发挥着越来越重要的作用。然而，CRAG的三大检测技术，即乳胶凝集试验（LA）、侧向流动分析（LFA）和酶联免疫吸附测定，存在一定局限性。虽然这些技术不常导致假阳性结果，但一旦在特定患者群体（如人类免疫缺陷病毒患者）中出现这种结果，可能会导致严重后果。
在我们报告的三例病例中，我们发现样本稀释不足可能导致隐球菌荚膜抗原检测出现假阳性结果，此前从未有过相关报道。
因此，一旦检测结果与临床症状不符，有必要仔细重新检测样本。特别是对于LFA和LA，可对样本进行充分稀释或分段稀释以避免假阳性结果。当然，在诊断中，还应改进液体和组织培养，结合影像学、墨汁染色等方法进一步提高诊断的准确性。
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