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Cryptococcal Antigen in Serum and Cerebrospinal Fluid for Detecting Cryptococcal Meningitis in Adults Living With Human Immunodeficiency Virus: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies.

Publication ,  Journal Article
Temfack, E; Rim, JJB; Spijker, R; Loyse, A; Chiller, T; Pappas, PG; Perfect, J; Sorell, TC; Harrison, TS; Cohen, JF; Lortholary, O
Published in: Clin Infect Dis
April 8, 2021

Cryptococcal antigen (CrAg) detection could direct the timely initiation of antifungal therapy. We searched MEDLINE and Embase for studies where CrAg detection in serum/cerebrospinal fluid (CSF) and CSF fungal culture were done on adults living with human immunodeficiency virus (HIV) who had suspected cryptococcal meningitis (CM). With Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), we evaluated the risk of bias in 11 included studies with 3600 participants, and used a random-effects meta-analysis to obtain summary sensitivity and specificity of serum and CSF CrAg, as well as agreement between CSF CrAg and CSF culture. Summary sensitivity and specificity of serum CrAg were 99.7% (97.4-100) and 94.1% (88.3-98.1), respectively, and summary sensitivity and specificity of CSF CrAg were 98.8% (96.2-99.6) and 99.3% (96.7-99.9), respectively. Agreement between CSF CrAg and CSF culture was 98% (97-99). In adults living with HIV who have CM symptoms, serum CrAg negativity may rule out CM, while positivity should prompt induction antifungal therapy if lumbar puncture is not feasible. In a first episode of CM, CSF CrAg positivity is diagnostic.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

April 8, 2021

Volume

72

Issue

7

Start / End Page

1268 / 1278

Location

United States

Related Subject Headings

  • Microbiology
  • Meningitis, Cryptococcal
  • Humans
  • HIV Infections
  • HIV
  • Diagnostic Tests, Routine
  • Cryptococcus
  • Antigens, Fungal
  • Adult
  • AIDS-Related Opportunistic Infections
 

Citation

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Temfack, E., Rim, J. J. B., Spijker, R., Loyse, A., Chiller, T., Pappas, P. G., … Lortholary, O. (2021). Cryptococcal Antigen in Serum and Cerebrospinal Fluid for Detecting Cryptococcal Meningitis in Adults Living With Human Immunodeficiency Virus: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies. Clin Infect Dis, 72(7), 1268–1278. https://doi.org/10.1093/cid/ciaa1243
Temfack, Elvis, Jean Joel Bigna Rim, Rene Spijker, Angela Loyse, Tom Chiller, Peter G. Pappas, John Perfect, et al. “Cryptococcal Antigen in Serum and Cerebrospinal Fluid for Detecting Cryptococcal Meningitis in Adults Living With Human Immunodeficiency Virus: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies.Clin Infect Dis 72, no. 7 (April 8, 2021): 1268–78. https://doi.org/10.1093/cid/ciaa1243.
Temfack E, Rim JJB, Spijker R, Loyse A, Chiller T, Pappas PG, Perfect J, Sorell TC, Harrison TS, Cohen JF, Lortholary O. Cryptococcal Antigen in Serum and Cerebrospinal Fluid for Detecting Cryptococcal Meningitis in Adults Living With Human Immunodeficiency Virus: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies. Clin Infect Dis. 2021 Apr 8;72(7):1268–1278.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

April 8, 2021

Volume

72

Issue

7

Start / End Page

1268 / 1278

Location

United States

Related Subject Headings

  • Microbiology
  • Meningitis, Cryptococcal
  • Humans
  • HIV Infections
  • HIV
  • Diagnostic Tests, Routine
  • Cryptococcus
  • Antigens, Fungal
  • Adult
  • AIDS-Related Opportunistic Infections