TEST CATALOG ORDERING & RESULTS SPECIMEN HANDLING CUSTOMER SERVICE EDUCATION & INSIGHTS
Test Catalog

Test ID: SLFA    
Cryptococcus Antigen Screen with Titer, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Aiding in the diagnosis of cryptococcosis

 

This test should not be used as a test of cure or to guide treatment decisions.

 

This test should not be used as a screening procedure for the general populations.

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If result is positive, Cryptococcus titer will be performed at an additional charge.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Cryptococcosis is an invasive fungal infection caused by Cryptococcus neoformans or Cryptococcus gattii. C neoformans has been isolated from several sites in nature, particularly weathered pigeon droppings. C gatti was previously associated with tropical and subtropical regions only; however, more recently this organism has also been found to be endemic in British Columbia and among the Pacific Northwest United States and is associated with several different trees species.

 

Infection is usually acquired via the pulmonary route. Patients are often unaware of any exposure history. Approximately half of the patients with symptomatic disease have a predisposing immunosuppressive condition such as AIDS, steroid therapy, lymphoma, or sarcoidosis. Symptoms may include fever, headache, dizziness, ataxia, somnolence, and cough. While the majority of C neoformans infections occur in immunocompromised patient populations, C gattii is has a higher predilection for infection of healthy individuals.(1,2)

 

In addition to the lungs, cryptococcal infections frequently involve the central nervous system (CNS), particularly in patients infected with HIV. Mortality among patients with CNS cryptococcosis may approach 25% despite antibiotic therapy. Untreated CNS cryptococcosis is invariably fatal. Disseminated disease may affect any organ system and usually occurs in immunosuppressed individuals.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Negative

Interpretation Provides information to assist in interpretation of the test results

The presence of cryptococcal antigen in any body fluid (serum or cerebrospinal fluid) is indicative of cryptococcosis. Specimens that are positive by the lateral flow assay screen are automatically repeated with the same method utilizing dilutions in order to generate a titer value.

 

Disseminated infection is usually accompanied by a positive serum test.

 

Higher Cryptococcus antigen titers appear to correlate with more severe infections. Declining titers may indicate regression of infection. However, monitoring titers to cryptococcal antigen should not be used as a test of cure or to guide treatment decisions, as low level titers may persist for extended periods of time following appropriate therapy and the resolution of infection.(3)

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

A negative result does not preclude diagnosis of cryptococcosis, particularly if only a single specimen has been tested and the patient shows symptoms consistent with cryptococcosis. 

 

A positive result is indicative of cryptococcosis, however all test results should be reviewed in light of other clinical findings.

 

Testing should not be performed as a screening procedure for the general populations and should only be performed when clinical evidence suggests the diagnosis of cryptococcal disease.

 

Testing hemolyzed serum specimens may lead to false-negative results due to the high background color on the lateral flow assay strip.

 

Although rare, extremely high concentrations of cryptococcal antigen can result in weak test lines and in extreme instances, yield negative test results.

 

This assay has not been evaluated for cross-reactivity in patients with trichosporonosis.

Supportive Data

There were 634 serum specimens (632 prospective and 2 archived) tested in a blinded fashion by the IMMY Cryptococcus antigen lateral flow assay (LFA), the Meridian latex agglutination (Meridian Bioscience Inc) assay, and the Meridian Cryptococcus antigen enzyme immunoassay (EIA) within a 24-hour period. Specimens with discordant results after initial testing were repeated by both assays during the same freeze/thaw cycle. The results are summarized below:

 

Table 1. Comparison of the IMMY LFA to the Meridian latex agglutination assay

 

Meridian latex agglutination

IMMY LFA

 

Positive

Negative

Total

Positive

9

1*

10

Negative

0

624

624

 Total

9

625

634

*This sample showed 1+ reactivity by the Meridian latex agglutination assay upon screening, but was interpreted as negative according to the package insert requirement for 2+ reactivity.

Sensitivity: 100% (9/9); 95% CI: 65.5%-100%

Specificity: 99.8% (624/625); 95% CI: 99.0%-99.9%

Overall Percent Agreement: 99.8% (633/634); 95% CI: 99.0%-99.9%

 

Table 2. Comparison of the IMMY LFA to the Meridian Cryptococcus antigen EIA

 

Meridian EIA

IMMY LFA

 

Positive

Negative

Total

Positive

5

5*

10

Negative

0

624

624

 Total

5

629

634

*These 5 samples were positive by the Meridian latex agglutination assay

Sensitivity: 100% (5/5); CI: 51.7%-100%

Specificity: 99.2% (624/629); CI: 98.1%-99.7%

Overall Percent Agreement: 99.2% (629/634); CI: 98.1%-99.7%

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Speed B, Dunt D: Clinical and host differences between infections with the two varieties of Cryptococcus neoformans. Clin Infect Dis. 1995;21(1):28-34

2. Chen S, Sorrell T, Nimmo G, et al: Epidemiology and host- and variety-dependent characteristics of infection due to Cryptococcus neoformans in Australia and New Zealand. Australasian Cyrptococcoal Study Group. Clin Infect Dis. 2000;31(2):499-505

3. Perfect JR, Dismukes WE, Dromer F, et al: Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. 2009;50:291-322

4. Warren NG, Hazen KC: Candida, Cryptococcus, and other yeasts of medical importance. In: Murray PR, ed. Manual of Clinical Microbiology. 7th ed. ASM Press; 1999: 1184-1199

5. Lu H, Zhou Y, Yin Y, et al: Cryptococcal antigen test revisited: significance for cryptococcal meningitis therapy monitoring in a tertiary Chinese hospital. J Clin Microbiol. 2005 June;43(6):2989-2990

6. Perfect JR: Cryptococcosis (Cryptococcus neoformans and Cryptococcus gattii). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020:3146-3161