1
|
Liu Y, Kang M, Wu SY, Wu LJ, He L, Xiao YL, Zhang WL, Liao QF, Deng J, Chen ZX, Ma Y. Evaluation of a Cryptococcus Capsular Polysaccharide Detection FungiXpert LFA (Lateral Flow Assay) for the Rapid Diagnosis of Cryptococcosis. Med Mycol 2022; 60:6562084. [PMID: 35362524 DOI: 10.1093/mmy/myac020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/22/2022] [Indexed: 02/05/2023] Open
Abstract
Cryptococcus is an opportunistic pathogenic fungus and is the major cause of fungal meningitis. The cryptococcal antigen (CrAg) lateral flow assay (LFA) is an immunochromatographic test system that has simplified diagnosis as a point-of-care test. In this study, we evaluated the diagnostic performance of Cryptococcal capsular polysaccharide detection FungiXpert (Genobio Pharmaceutical, Tianjin, China) using serum and cerebrospinal fluid (CSF) samples for the diagnosis of cryptococcosis and investigated the cross-reaction of the assays to pathogenic fungi and bacterium by comparing it to the U.S. Food and Drug Administration (US FDA)-approved IMMY CrAg LFA. Eighty CSF and 119 serum/plasma samples from 158 patients were retrospectively collected to test for qualitative or semi-quantitative detection of CrAg. Cross-reaction of the assays was tested using 28 fungi and 1 bacterium. Compared to IMMY CrAg LFA, the FungiXpert LFA demonstrated 99.1% sensitivity and 98.9% specificity in the qualitative test. In the 96 semi-quantitative CrAg assay results, 39 (40.6%) test titers of FungiXpert LFA were 1-2 dilutions higher than those of IMMY CrAg LFA. The Intraclass Correlation Coefficient of the Semi-quantitative results of CrAg titer tests via the two assays was 0.976. Similar to IMMY CrAg LFA, FungiXpert LFA showed cross-reactivity with Trichosporon asahii. Compared with the IMMY CrAg LFA, the FungiXpert LFA showed an equal, yet, excellent performance. However, it is important to note that these two assays have potential cross-reactivity to T. asahii when diagnosing patients. FungiXpert LFA is a rapid screening method for the effective and practical diagnosis and treatment of cryptococcosis.
Collapse
Affiliation(s)
- Ya Liu
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital Sichuan University, Chengdu, China
| | - Mei Kang
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital Sichuan University, Chengdu, China
| | - Si-Ying Wu
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital Sichuan University, Chengdu, China
| | - Li-Juan Wu
- Department of Laboratory Medicine, Guigang City People's Hospital, Guigang, China
| | - Lan He
- Department of Laboratory Medicine, The Sixth People's Hospital of Chengdu, Chengdu, China
| | - Yu-Ling Xiao
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital Sichuan University, Chengdu, China
| | - Wei-Li Zhang
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital Sichuan University, Chengdu, China
| | - Quan-Feng Liao
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital Sichuan University, Chengdu, China
| | - Jin Deng
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital Sichuan University, Chengdu, China
| | - Zhi-Xing Chen
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital Sichuan University, Chengdu, China
| | - Ying Ma
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital Sichuan University, Chengdu, China
| |
Collapse
|
2
|
Alveolar Proteinosis Secondary to M. tuberculosis, in a Patient with Transient CD4 Lymphocytopenia Due to Cryptococcus neoformans Infection: First Case in the Literature. Infect Dis Rep 2022; 14:169-175. [PMID: 35314651 PMCID: PMC8938766 DOI: 10.3390/idr14020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/27/2022] [Accepted: 03/02/2022] [Indexed: 12/04/2022] Open
Abstract
Transient CD4 lymphocytopenia is defined as the transitory presence of CD4+ T lymphocyte fewer than 300 cells/mm3 or less than 20% of T cells without HIV infection. It can occur due to multiple causes; however, it is rare for it to occur due to opportunistic infections. Few cases have been described in the literature where antimicrobial treatment normalizes the CD4 count, being more frequent in Mycobacterium tuberculosis infections. To date, this phenomenon has not been described in Cryptococcus neoformans infections. This would be the first reported case according to our knowledge, of a patient who normalizes CD4 count after antifungal treatment, later developing alveolar proteinosis due to M. Tuberculosis.
Collapse
|
3
|
Production of Secreted Carbohydrates that Present Immunologic Similarities with the Cryptococcus Glucuronoxylomannan by Members of the Trichosporonaceae Family: A Comparative Study Among Species of Clinical Interest. Mycopathologia 2021; 186:377-385. [PMID: 33956292 DOI: 10.1007/s11046-021-00558-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/22/2021] [Indexed: 10/20/2022]
Abstract
Glucuronoxylomannan (GXM) participates in several immunoregulatory mechanisms, which makes it an important Cryptococcus virulence factor that is essential for the disease. Trichosporon asahii and Trichosporon mucoides share with Cryptococcus species the ability to produce GXM. To check whether other opportunistic species in the Trichosporonaceae family produce GXM-like polysaccharides, extracts from 28 strains were produced from solid cultures and their carbohydrate content evaluated by the sulfuric acid / phenol method. Moreover, extracts were assessed for cryptococcal GXM cross-reactivity through latex agglutination and lateral flow assay methods. Cryptococcus neoformans and Saccharomyces cerevisiae were used as positive and negative controls, respectively. In addition to T. asahii, the species Trichosporon inkin, Apiotrichum montevideense, Trichosporon japonicum, Trichosporon faecale, Trichosporon ovoides, Cutaneotrichosporon debeurmannianum, and Cutaneotrichosporon arboriformis are also producers of a polysaccharide immunologically similar to the GXM produced by human pathogenic Cryptococcus species. The carbohydrate concentration of the extracts presented a positive correlation with the GXM contents determined by titration of both methodologies. These results add several species to the list of fungal pathogens that produce glycans of the GXM type and bring information about the origin of potential false-positive results on immunological tests for diagnosis of cryptococcosis based on GXM detection.
Collapse
|
4
|
Harrington KRV, Wang YF, Rebolledo PA, Liu Z, Yang Q, Kempker RR. Evaluation of a Cryptococcal Antigen Lateral Flow Assay and Cryptococcal Antigen Positivity at a Large Public Hospital in Atlanta, Georgia. Open Forum Infect Dis 2021; 8:ofab123. [PMID: 34189154 PMCID: PMC8233569 DOI: 10.1093/ofid/ofab123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cryptococcus neoformans is a major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected persons worldwide, and there are scarce recent data on cryptococcal antigen (CrAg) positivity in the United States We sought to determine the frequency of cryptococcal disease and compare the performance of a CrAg lateral flow assay (LFA) versus latex agglutination (LA) test. METHODS All patients from Grady Health System in Atlanta who had a serum or cerebrospinal fluid (CSF) sample sent for CrAg testing as part of clinical care from November 2017 to July 2018 were included. Percentage positivity and test agreement were calculated. RESULTS Among 467 patients, 557 diagnostic tests were performed; 413 on serum and 144 on CSF. The mean age was 44 years, and most were male (69%) and had HIV (79%). Twenty-four (6.4%, 95% confidence interval [CI] = 4.1-9.4) patients were serum CrAg positive, and 8 (5.8%, 95% CI = 2.6-11.2) individuals tested positive for CSF CrAg. Although overall agreement between the LA and LFA was substantial to high for CSF (κ = 0.71, 95% CI = 0.51-0.91) and serum (κ = 0.93, 95% CI = 0.86-1.00), respectively, there were important discrepancies. Five patients had false-positive CSF LA tests that affected clinical care, and 4 patients had discordant serum tests. CONCLUSIONS We found a moderately high proportion of cryptococcal disease and important discrepancies between the LA test and LFA. Clinical implications of these findings include accurate detection of serum CrAg and averting unnecessary treatment of meningitis with costly medications associated with high rates of adverse events.
Collapse
Affiliation(s)
- Kristin R V Harrington
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA,Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA,Correspondence: Kristin R. V. Harrington, BS, Department of Epidemiology, Rollins School of Public Health, Emory University, 3rd Floor, Claudia Nance Rollins Building, 1518 Clifton Road, Atlanta, Georgia, USA 30322 ()
| | - Yun F Wang
- Emory University School of Medicine, Department of Pathology & Laboratory Medicine, Atlanta, Georgia, USA,Grady Memorial Hospital, Department of Pathology & Clinical Laboratories, Atlanta, Georgia, USA
| | - Paulina A Rebolledo
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA,Emory University Rollins School of Public Health, Department of Global Health, Atlanta, Georgia, USA
| | - Zhiyong Liu
- Grady Memorial Hospital, Department of Pathology & Clinical Laboratories, Atlanta, Georgia, USA
| | - Qianting Yang
- Grady Memorial Hospital, Department of Pathology & Clinical Laboratories, Atlanta, Georgia, USA
| | - Russell R Kempker
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA
| |
Collapse
|
5
|
Moniot M, Lavergne RA, Morel T, Guieze R, Morio F, Poirier P, Nourrisson C. Hormographiella aspergillata: an emerging basidiomycete in the clinical setting? A case report and literature review. BMC Infect Dis 2020; 20:945. [PMID: 33308180 PMCID: PMC7731474 DOI: 10.1186/s12879-020-05679-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/02/2020] [Indexed: 12/03/2022] Open
Abstract
Background Filamentous basidiomycetes are mainly considered to be respiratory tract colonizers but the clinical significance of their isolation in a specimen is debatable. Hormographiella aspergillata was first reported as a human pathogen in 1971. We discuss the role of this mold as a pathogen or colonizer and give an update on diagnostic tools and in vitro antifungal susceptibility. Case presentation We identified three cases of H. aspergillata with respiratory symptoms in a short period of time. One invasive infection and two colonizations were diagnosed. Culture supernatants showed that H. aspergillata can produce galactomannan and β-D-glucan but not glucuronoxylomannan. For the first time, isavuconazole susceptibility was determined and high minimum inhibitory concentrations (MICs) were found. Liposomal amphotericin B and voriconazole have the lowest MICs. Conclusion To date, 22 invasive infections involving H. aspergillata have been reported. On isolation of H. aspergillata, its pathogenic potential in clinical settings can be tricky. Molecular identification and antifungal susceptibility testing are essential considering high resistance against several antifungal therapies.
Collapse
Affiliation(s)
- Maxime Moniot
- Laboratoire de Parasitologie-Mycologie, CHU Clermont-Ferrand, CHU Gabriel Montpied, 58 rue Montalembert, 3IHP, 63003, Clermont-Ferrand Cedex 1, France. .,Equipe Interactions Hôte-Parasite, Laboratoire Microorganismes : Génome et Environnement, CNRS, Université Clermont-Auvergne, Clermont-Ferrand, France.
| | - Rose-Anne Lavergne
- Laboratoire de Parasitologie-Mycologie, Département de Mycologie Médicale, Hôpitaux Universitaires de Nantes, Universités Nantes Atlantique, EA1155-IICiMed, Institut de Recherche en Santé 2, Nantes, France
| | - Thomas Morel
- Laboratoire de Parasitologie-Mycologie, CHU Clermont-Ferrand, CHU Gabriel Montpied, 58 rue Montalembert, 3IHP, 63003, Clermont-Ferrand Cedex 1, France
| | - Romain Guieze
- Service d'Hématologie Clinique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Florent Morio
- Laboratoire de Parasitologie-Mycologie, Département de Mycologie Médicale, Hôpitaux Universitaires de Nantes, Universités Nantes Atlantique, EA1155-IICiMed, Institut de Recherche en Santé 2, Nantes, France
| | - Philippe Poirier
- Laboratoire de Parasitologie-Mycologie, CHU Clermont-Ferrand, CHU Gabriel Montpied, 58 rue Montalembert, 3IHP, 63003, Clermont-Ferrand Cedex 1, France.,Equipe Interactions Hôte-Parasite, Laboratoire Microorganismes : Génome et Environnement, CNRS, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Céline Nourrisson
- Laboratoire de Parasitologie-Mycologie, CHU Clermont-Ferrand, CHU Gabriel Montpied, 58 rue Montalembert, 3IHP, 63003, Clermont-Ferrand Cedex 1, France.,Equipe Interactions Hôte-Parasite, Laboratoire Microorganismes : Génome et Environnement, CNRS, Université Clermont-Auvergne, Clermont-Ferrand, France
| |
Collapse
|
6
|
Izumikawa K, Kakeya H, Sakai F, Shibuya K, Sugita T, Takazono T, Takata T, Tashiro M, Teruya K, Nakamura S, Noguchi H, Hiruma M, Makimura K, Miyazaki T, Miyazaki Y, Yamagishi Y, Yoshida K, Watanabe A. Executive Summary of JSMM Clinical Practice Guidelines for Diagnosis and Treatment of Cryptococcosis 2019. Med Mycol J 2020; 61:61-89. [PMID: 33250505 DOI: 10.3314/mmj.20.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences
| | - Hiroshi Kakeya
- Department of Infection Control Science, Osaka City University Graduate School of Medicine
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center
| | - Kazutoshi Shibuya
- Department of Pathology, Omori Hospital, Toho University School of Medicine
| | - Takashi Sugita
- Department of Microbiology, Meiji Pharmaceutical University
| | - Takahiro Takazono
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences
| | - Tohru Takata
- Department Oncology, Hematology, and Infectious Diseases, Fukuoka University Hospital
| | - Masato Tashiro
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences
| | - Katsuji Teruya
- AIDS Clinical Center, National Center for Global Health and Medicine
| | - Shigeki Nakamura
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases.,Department of Microbiology, Tokyo Medical University
| | | | | | - Koichi Makimura
- Medical Mycology, Graduate School of Medicine, Teikyo University
| | - Taiga Miyazaki
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine
| | - Koichiro Yoshida
- Department of Medical Safety Management, Division of Infection Control and Prevention, Kindai University Hospital
| | - Akira Watanabe
- Division of Clinical Research, Medical Mycology Research Center, Chiba University
| |
Collapse
|
7
|
Melo ASDA, Santos DWDCL, Lima SL, Rodrigues AM, Camargo ZP, Finkelman M, Colombo AL. Evaluation of (1 → 3)‐β‐D‐glucan assay for diagnosing paracoccidioidomycosis. Mycoses 2019; 63:38-42. [DOI: 10.1111/myc.13007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Analy Salles de Azevedo Melo
- Laboratório Especial de Micologia Departamento de Medicina Universidade Federal de São Paulo (UNIFESP) São Paulo Brasil
| | | | - Soraia Lopes Lima
- Laboratório Especial de Micologia Departamento de Medicina Universidade Federal de São Paulo (UNIFESP) São Paulo Brasil
| | - Anderson Messias Rodrigues
- Laboratório de Patógenos Fúngicos Emergentes Departamento de Microbiologia, Imunologia e Parasitologia Universidade Federal de São Paulo (UNIFESP) São Paulo Brazil
| | - Zoilo Pires Camargo
- Laboratório de Micologia Médica Departamento de Microbiologia, Imunologia e Parasitologia Universidade Federal de São Paulo (UNIFESP) São Paulo Brazil
| | - Malcolm Finkelman
- Associates of Cape Cod Clinical Development Department Research Laboratory Falmouth MA USA
| | - Arnaldo Lopes Colombo
- Laboratório Especial de Micologia Departamento de Medicina Universidade Federal de São Paulo (UNIFESP) São Paulo Brasil
| |
Collapse
|
8
|
Bahr NC, Panackal AA, Durkin MM, Smedema ML, Keown W, Davis TE, Raymond-Guillen L, Park YD, Marr KA, Fries BC, Williamson PR, Boulware DR, Wheat LJ. Cryptococcal meningitis is a cause for cross-reactivity in cerebrospinal fluid assays for anti-Histoplasma, anti-Coccidioides and anti-Blastomyces antibodies. Mycoses 2019; 62:268-273. [PMID: 30565753 DOI: 10.1111/myc.12882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Antibody detection is commonly used for diagnosis of histoplasmosis, and cross-reactions have been recognised due to endemic mycoses but not cryptococcosis. We observed cross-reactions in an anti-Histoplasma antibody enzyme immunoassay (EIA) in the cerebrospinal fluid (CSF) from a patient with cryptococcal meningitis and sought to assess the risk of cross-reactive anti-Histoplasma antibodies in persons with cryptococcal meningitis. METHODS An anti-cryptococcal antibody EIA was developed to measure CSF antibody response in HIV-infected subjects from Kampala, Uganda and previously healthy, HIV-negative subjects at the National Institutes of Health (NIH) with cryptococcal meningitis. Specimens were tested for cross-reactivity in assays for IgG anti-Histoplasma, anti-Blastomyces and anti-Coccidioides antibodies. RESULTS Among 61 subjects with cryptococcal meningitis (44 Kampala cohort, 17 NIH cohort), elevated CSF anti-cryptococcal antibody levels existed in 38% (23/61). Of the 23 CSF specimens containing elevated anti-cryptococcal antibodies, falsely positive results were detected in antibody EIAs for histoplasmosis (8/23, 35%), coccidioidomycosis (6/23, 26%) and blastomycosis (1/23, 4%). Overall, 2% (2/81) of control CSF specimens had elevated anti-cryptococcal antibody detected, both from Indiana. CONCLUSIONS Cryptococcal meningitis may cause false-positive results in the CSF for antibodies against Histoplasma, Blastomyces and Coccidioides. Fungal antigen testing should be performed to aid in differentiating true- and false-positive antibody results in the CSF.
Collapse
Affiliation(s)
- Nathan C Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, Kansas
| | - Anil A Panackal
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | - Wesley Keown
- MiraVista Diagnostics, Indianapolis, Indianapolis, Indiana
| | - Thomas E Davis
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana
| | - Luke Raymond-Guillen
- Division of Infectious Diseases, Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Yoon-Dong Park
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Kieren A Marr
- Division of Infectious Disease, Department of Medicine Johns Hopkins, Baltimore, Maryland
| | - Bettina C Fries
- Division of Infectious Disease, Department of Medicine, Stony Brook School of Medicine, Stony Brook, New York
| | - Peter R Williamson
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - David R Boulware
- Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - L Joseph Wheat
- MiraVista Diagnostics, Indianapolis, Indianapolis, Indiana
| |
Collapse
|