Test Catalog

Test Id : CLFA

Cryptococcus Antigen Screen with Titer, Spinal Fluid

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

Aiding in the diagnosis of cryptococcosis

 

This test should not be performed as a screening procedure for the general population.

 

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

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.

 

For more information see Meningitis/Encephalitis Panel Algorithm

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Name
A short description of the method used to perform the test

Lateral Flow Assay (LFA)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Cryptococcus Ag Screen w/Titer, CSF

Aliases
Lists additional common names for a test, as an aid in searching

Cryptococcus Ag Screen, CSF

Cryptococcus gattii

Cryptococcus neoformans

Fungal Serology

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.

 

For more information see Meningitis/Encephalitis Panel Algorithm

Specimen Type
Describes the specimen type validated for testing

CSF

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Container/Tube: Sterile vial

Specimen Volume: 1 mL

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Forms

If not ordering electronically, complete, print, and send Infectious Disease Serology Test Request (T916) with the specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.5 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
CSF Refrigerated (preferred) 14 days
Frozen 14 days

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

Aiding in the diagnosis of cryptococcosis

 

This test should not be performed as a screening procedure for the general population.

 

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

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.

 

For more information see Meningitis/Encephalitis Panel Algorithm

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. Cryptococcus neoformans has been isolated from several sites in nature, particularly weathered pigeon droppings. C gattii 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 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.

 

Note: According to the College of American Pathologists (CAP, IMM.41840), cerebrospinal fluid (CSF) samples submitted for initial diagnosis, which test positive by the lateral flow assay, should also be submitted for routine fungal culture. Fungal cultures are not required for CSF samples that are submitted to monitor Cryptococcus antigen titers during treatment.

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

Reference values apply to all ages.

Interpretation
Provides information to assist in interpretation of the test results

The presence of cryptococcal antigen in any body fluid (serum or cerebrospinal fluid: CSF) is indicative of cryptococcosis. Specimens that are positive by the lateral flow assay (LFA) screen are automatically repeated by the same method utilizing dilutions in order to generate a titer value. CSF specimens submitted for initial diagnosis, which test positive by LFA, should also be submitted for routine fungal culture. Culture can aid to differentiate between the 2 common Cryptococcus species causing disease (Cryptococcus neoformans and Cryptococcus gattii) and can be used for antifungal susceptibility testing, if necessary. CSF specimens submitted to monitor antigen levels during treatment do not need to be cultured.

 

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 traumatic lumbar puncture and contamination of the cerebrospinal fluid (CSF) specimen with serum may lead to a positive Cryptococcus antigen result from CSF in patients without neuroinvasive cryptococcosis.

 

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.

 

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

 

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

Supportive Data

Cerebrospinal fluid (CSF) retrospective specimens (111) were tested in a blinded fashion by the IMMY Cryptococcus Antigen Lateral Flow Assay (LFA; Normon, OK) and the Meridian Latex Agglutination (Meridian Bioscience Inc, Cincinnati, OH) assay within a 24-hour period. Of these 111 specimens, 45 were also tested by the Meridian Cryptococcus Antigen enzyme immunoassay (EIA) also within a 24-hour period. Samples with discordant results after initial testing were repeated by both assays during the same freeze/thaw cycle. The results are summarized below in Table 1 and Table 2:

 

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

 

Meridian latex agglutination

LFA IMMY

 

Positive

Negative

Total

Positive

18

0

18

Negative

0

93

93

Total

18

93

111

Sensitivity: 100% (18/18); 95% CI: 81.2%-100%

Specificity: 100% (93/93); 95% CI: 96.0%-100%

Overall Percent Agreement: 100% (111/111); 95% CI: 99.0%-100%

 

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

 

Meridian EIA

LFA IMMY

 

Positive

Negative

Total

Positive

12

0

12

Negative

0

33

33

Total

12

33

45

Sensitivity: 100% (12/12); 95% CI: 72.2%-100%

Specificity: 100% (33/33); 95% CI: 87.8%-100%

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. Clin Infect Dis. 2010;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

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Description
Describes how the test is performed and provides a method-specific reference

The Cryptococcus antigen (CrAg) lateral flow assay is a sandwich immunochromatographic assay. Specimens and diluent are added to a test tube and the lateral flow device is added. The test uses specimen wicking to capture gold-conjugated, anti-cryptococcal antigen monoclonal antibodies and gold-conjugated control antibodies deposited on the test membrane. If cryptococcal antigen is present in the specimen, it binds to the gold-conjugated, anti-cryptococcal antigen antibodies. This complex wicks up the membrane and interacts with the test line, which has immobilized anti-cryptococcal antigen monoclonal antibodies. The antigen-antibody complex forms a sandwich at the test line causing a visible line to form. A valid test shows a visible line at the control line. Positive test results create 2 lines (control and specimen), while negative results form only the control line.(Package insert: CrAg Lateral Flow Assay. IMMY; Rev 2012)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Sunday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

Same day/1 to 2 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

14 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

87899-Cryptococcus screen

87899-Cryptococcus titer (if appropriate)

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports