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- Title
Evaluation of a point-of-care immunoassay test kit ‘StrongStep’ for cryptococcal antigen detection.
- Authors
Mpoza, Edward; Mukaremera, Liliane; Kundura, Didas Atwebembere; Akampurira, Andrew; Luggya, Tonny; Tadeo, Kiiza Kandole; Pastick, Katelyn A.; Bridge, Sarah C.; Tugume, Lillian; Kiggundu, Reuben; Musubire, Abdu K.; Williams, Darlisha A.; Muzoora, Conrad; Nalintya, Elizabeth; Rajasingham, Radha; Rhein, Joshua; Boulware, David R.; Meya, David B.; Abassi, Mahsa
- Abstract
Background: HIV-associated cryptococcal meningitis is the leading cause of adult meningitis in Sub-Saharan Africa, accounting for 15%–20% of AIDS-attributable mortality. The development of point-of-care assays has greatly improved the screening and diagnosis of cryptococcal disease. We evaluated a point-of-care immunoassay, StrongStep (Liming Bio, Nanjing, Jiangsu, China) lateral flow assay (LFA), for cryptococcal antigen (CrAg) detection in cerebrospinal fluid (CSF) and plasma. Methods: We retrospectively tested 143 CSF and 77 plasma samples collected from HIV-seropositive individuals with suspected meningitis from 2012–2016 in Uganda. We prospectively tested 90 plasma samples collected from HIV-seropositive individuals with CD4 cell count <100 cells/μL from 2016–2017 as part of a cryptococcal antigenemia screening program. The StrongStep CrAg was tested against a composite reference standard of positive Immy CrAg LFA (Immy, Norman, OK, USA) or CSF culture with statistical comparison by McNemar’s test. Results: StrongStep CrAg had a 98% (54/55) sensitivity and 90% (101/112) specificity in plasma (P = 0.009, versus reference standard). In CSF, the StrongStep CrAg had 100% (101/101) sensitivity and 98% (41/42) specificity (P = 0.99). Adjusting for the cryptococcal antigenemia prevalence of 9% in Uganda and average cryptococcal meningitis prevalence of 37% in Sub-Saharan Africa, the positive predictive value of the StrongStep CrAg was 50% in plasma and 96% in CSF. Conclusions: We found the StrongStep CrAg LFA to be a sensitive assay, which unfortunately lacked specificity in plasma. In lower prevalence settings, a majority of positive results from blood would be expected to be false positives.
- Subjects
IMMUNOASSAY; CRYPTOCOCCUS; ANTIGENS; POINT-of-care testing; MYCOSES; DIAGNOSIS
- Publication
PLoS ONE, 2018, Vol 13, Issue 1, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0190652