Article Figures & Data
Figures
- FIG 1
Summary of patients for whom serum and/or CSF samples were tested with the CrAg LFA between 1 June 2014 and 31 December 2016.
Tables
- TABLE 1
CrAg LFA and CALAS titers for patients with first-time diagnoses of cryptococcal disease confirmed by culture or histopathology (n = 20)
Patient no. Age (yr)/sex Source for fungal culture Time to growth (days) Source for CrAg assaya CrAg LFA titer CALAS titer 1 88/M CSF 4 CSF 1:20 Negative Serum ND ND 2 70/M CSF 2 CSF ≥1:2,560 ≥1:4,096 Serum 1:160 1:32 3 67/M Bronchial wash 7 Serum 1:5 Negative 4 78/F Bronchial wash 1 Serum 1:40 1:16 5 73/M Blood 2 Serum ≥1:2,560 ≥1:4,096 6 78/M Blood 2 Serum ≥1:2,560 ND 7 76/M CSF 2 CSF ≥1:2,560 1:2,048 Serum ≥1:2,560 1:1,024 8 57/M CSF 2 CSF ≥1:2,560 1:128 Serum 1:160 1:32 9 50/M BAL fluid 3 Serum 1:20 1:4 10 72/M CSF 2 CSF ≥1:2,560 1:512 Serum 1:640 1:64 11 71/M CSF 7 CSF ≥1:2,560 1:1,024 Serum ND ND 12 61/M CSF 2 CSF 1:20 1:1 Serum 1:20 1:4 13 63/M Urine 7 Serum 1:40 1:8 14 39/M CSF 2 CSF 1:640 1:64 Serum 1:2 Negative 15 48/F Calf tissue 5 Serum ≥1:2,560 1:1,024 16 58/F CSF 3 CSF 1:160 1:16 Serum 1:160 1:64 17 43/M CSF 2 CSF 1:320 1:128 Serum ≥1:2,560 1:128 18 58/M Lung tissue 2 Serum 1:20 1:16 19 52/M Lung tissueb NA Serum 1:10 1:2 20 30/M Sputum 2 Serum ≥1:2,560 ND ↵a CrAg, Cryptococcus antigen; ND, not done; NA, not applicable; BAL, bronchoalveolar lavage; LFA, lateral flow assay.
↵b Organisms consistent with Cryptococcus spp. were observed in the histopathological assessment of a lung biopsy specimen, using both Gomori methenamine silver (GMS) and mucicarmine stains.
- TABLE 2
Review of data for patients tested by the CrAg LFA without culture or histopathological confirmation of cryptococcal disease (n = 18)a
Patient no. Age (yr)/sex Presenting symptom(s) Comorbidity/immunosuppression Radiological findings Culture source CrAg LFA titer (source) CALAS titer (source) Final diagnosis Antifungal treatment initiated/response? Repeat CrAg LFA titer (days between tests)b 1 33/M Chronic dry cough S/p kidney Tx (2006); tacrolimus and mycophenolate Bilateral innumerable small lung nodules Blood, CSF 1:10 (S) Neg. (S) Probable cryptococcal pulmonary infection Fluconazole/yes 1:10 (3) 2 80/F Dyspnea, weight loss, fatigue Idiopathic pulmonary fibrosis Ground glass lung opacities Blood, CSF 1:10 (S) Neg. (S) Probable cryptococcal pulmonary infection Fluconazole/yes 1:2 (96), 1:2 (111) 3 60/F SOB, fever, HA, chronic cough S/p kidney Tx (2010), DM2; tacrolimus Bilateral nodular lung opacities Blood 1:1,280 (S) 1:256 (S) Probable cryptococcal pneumonia Fluconazole and flucytosine/yes 1:640 (13), 1:80 (153) 4 74/M Cough, weight loss, fatigue, fever Autoimmune hemolytic anemia; high-dose prednisone Cavitary lesion in right upper lobe Blood 1:40 (S) ND Probable cryptococcal pulmonary infection Fluconazole/yes 1:40 (30), 1:20 (123), neg. (10 mo) 5 53/M Severe HA, neck pain, fever, photophobia Newly diagnosed with HIV (48 CD4+ cells/mm3) None CSF ≥1:2,560 (CSF)c ≥1:4,096 (CSF) Cryptococcal meningitis Amphotericin B and flucytosine/yes ≥1:2,560 (CSF, 34) 6 68/M Fever, rigors, anorexia S/p liver Tx (2004), IBD; tacrolimus None Blood, CSF 1:2 (S) Neg. (S) Possible cryptococcal granulomatous hepatitis Fluconazole/no Neg. (2) 7 73/M Tremors, fever Monoclonal gammopathy, microscopic anemia Few punctate lung nodules Blood 1:5 (S) Neg. (S) Possible subacute cryptococcal infection, Waldenström's macroglobulinemia Fluconazole/no ND 8 85/M Hematuria, back pain S/p aortic valve replacement None Blood, CSF, spinal tissue, urine 1:2 (S) Neg. (S) Pseudomonas aeruginosa UTI, Streptococcusbovis spinal infection No/NA 1:2 (1) 9 51/F Fever, abdominal pain S/p liver Tx (2004); azathioprine and tacrolimus None Blood, urine 1:2 (S) Neg. (S) Large diffuse B-cell lymphoma Fluconazole/no 1:2 (2), neg. (75) 10 42/F Weight loss, fatigue, ARDS at admission Congenital urinary/lower GI abnormalities None Blood 1:2 (S) Neg. (S) ARDS secondary to adrenal insufficiency No/NA Neg. (2) 11 61/F Foot ulcer, hemodynamic instability Rheumatoid arthritis, DM2, ESRD with hemodialysis; etanercept None Blood, hip tissue 1:2 (S) Neg. (S) Cellulitis and contiguous osteomyelitis due to Staphylococcus aureus and Streptococcus pyogenes No/NA ND 12 46/M Fever, hip pain Total hip arthroplasty Bilateral lung nodules/opacities Blood 1:2 (S) Neg. (S) Candida albicans bloodstream infection Caspofungin for C. albicans infection/yes ND 13 88/F Gait disturbance, difficulty swallowing None Enlargement of left lateral pons CSF 1:2 (CSF)c Neg. (CSF) Glioma No/NA ND 14 61/M SOB, cough S/p allogeneic PBSC Tx (2015) Bilateral lung consolidation and septal thickening Blood, BAL fluid, CSF 1:2 (S) Neg. (S) Pulmonary GVHD Amphotericin B, switched to fluconazole/no Neg. (3) 15 43/F Right upper extremity weakness None Frontal lobe brain atrophy CSF 1:5 (CSF), neg. (S) Neg. (CSF), ND (S) Corticobasal degeneration No/NA Neg. (S, 1) 16 88/M Progressive neurological symptoms Coronary artery disease, lumbar fusion None Blood, CSF 1:2 (S) Neg. (S) Cauda equina nerve root enhancement No/NA ND 17 75/M Fever Gout, hypothyroidism Bilateral small lung nodules Blood 1:2 (S) ND Resolution with empiric levofloxacin No/NA Neg. (5) 18 60/M SOB, chronic cough, fatigue, fever Adenocarcinoma s/p chemoradiation (2016), HCV s/p ledipasvir (2016) Cavitary lung lesion, ground glass opacities Blood 1:2 (S) Neg. (S) Pneumonia due to Aspergillus fumigatus and Acinetobacterbaumannii/Acinetobacter calcoaceticus Fluconazole (discontinued)/no Neg. (22) ↵a S/p, status post; S, serum; UTI, urinary tract infection; BAL, bronchoalveolar lavage; NA, not applicable; ND, not done; neg., negative; Tx, transplant; ARDS, acute respiratory distress syndrome; GI, gastrointestinal; IBD, irritable bowel syndrome; PBSC, peripheral stem cell; GVHD, graft-versus-host disease; HA, headache; SOB, shortness of breath; DM2, diabetes mellitus type 2; ESRD, end-stage renal disease; HCV, hepatitis C virus.
↵b Indicates the time between the initial CrAg LFA result and the repeat test(s) ordered as part of clinical care.
↵c Serum samples were not evaluated for CrAg.
