Skip to main content
NCBI home page
Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1994 Jul;32(7):1680–1684. doi: 10.1128/jcm.32.7.1680-1684.1994

Comparison of commercial kits for detection of cryptococcal antigen.

D C Tanner 1, M P Weinstein 1, B Fedorciw 1, K L Joho 1, J J Thorpe 1, L Reller 1
PMCID: PMC263761  PMID: 7929757

Abstract

Although kits to detect cryptococcal antigen are used widely to diagnose cryptococcal infection, the comparative performance of commercially available assays has not been evaluated in the past decade. Therefore, we compared the sensitives and specificities of five commercially available kits for detecting cryptococcal antigen (four latex agglutination test kits--Calas [Meridian Diagnostics])--Crypto-LA [International Biological Labs], Myco-Immune [MicroScan], and Immy [Immunomycologics]--and an enzyme immunoassay kit, Premier [Meridian Diagnostics]) with culture for the diagnosis of cryptococcal meningitis and fungemia. Of 182 cerebrospinal fluid (CSF) and 90 serum samples submitted for cryptococcal antigen and fungal culture, 49 (19 and 30 samples, respectively) from 20 patients had a culture positive for Cryptococcus neoformans. For CSF specimens, the sensitivities and specificities of all kits were comparable (sensitivity, 93 to 100%; specificity, 93 to 98%). There was a significant difference in sensitivities of the kits when serum samples were tested with the International Biological Labs and MicroScan kits, which do not pretreat serum with pronase. These kits were less sensitive (sensitivity, 83%) than the Immy and Meridian latex kits (sensitivity, 97%), which do pretreat with pronase. The sensitivity of the Meridian enzyme immunoassay kit was comparable to that of the pronase-containing latex kits. These kits were of equivalent specificities (93 to 100%) when testing serum. Some of the currently available kits have limitations that need to be recognized for proper interpretation of results. Specifically, the use of pronase on serum samples reduces the number of false-positive results, and a titer of < or = 1:4 can be a false-positive result when CSF samples are being tested.

Full text

PDF
1680

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bennett J. E., Dismukes W. E., Duma R. J., Medoff G., Sande M. A., Gallis H., Leonard J., Fields B. T., Bradshaw M., Haywood H. A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptoccal meningitis. N Engl J Med. 1979 Jul 19;301(3):126–131. doi: 10.1056/NEJM197907193010303. [DOI] [PubMed] [Google Scholar]
  2. Bozzette S. A., Larsen R. A., Chiu J., Leal M. A., Jacobsen J., Rothman P., Robinson P., Gilbert G., McCutchan J. A., Tilles J. A placebo-controlled trial of maintenance therapy with fluconazole after treatment of cryptococcal meningitis in the acquired immunodeficiency syndrome. California Collaborative Treatment Group. N Engl J Med. 1991 Feb 28;324(9):580–584. doi: 10.1056/NEJM199102283240902. [DOI] [PubMed] [Google Scholar]
  3. Chuck S. L., Sande M. A. Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome. N Engl J Med. 1989 Sep 21;321(12):794–799. doi: 10.1056/NEJM198909213211205. [DOI] [PubMed] [Google Scholar]
  4. Clark R. A., Greer D., Atkinson W., Valainis G. T., Hyslop N. Spectrum of Cryptococcus neoformans infection in 68 patients infected with human immunodeficiency virus. Rev Infect Dis. 1990 Sep-Oct;12(5):768–777. doi: 10.1093/clinids/12.5.768. [DOI] [PubMed] [Google Scholar]
  5. Denning D. W., Tucker R. M., Hanson L. H., Hamilton J. R., Stevens D. A. Itraconazole therapy for cryptococcal meningitis and cryptococcosis. Arch Intern Med. 1989 Oct;149(10):2301–2308. [PubMed] [Google Scholar]
  6. Diamond R. D., Bennett J. E. Prognostic factors in cryptococcal meningitis. A study in 111 cases. Ann Intern Med. 1974 Feb;80(2):176–181. doi: 10.7326/0003-4819-80-2-176. [DOI] [PubMed] [Google Scholar]
  7. Dolan C. T. Specificity of the latex-cryptococcal antigen test. Am J Clin Pathol. 1972 Oct;58(4):358–364. doi: 10.1093/ajcp/58.5.358. [DOI] [PubMed] [Google Scholar]
  8. Eng R. H., Bishburg E., Smith S. M., Kapila R. Cryptococcal infections in patients with acquired immune deficiency syndrome. Am J Med. 1986 Jul;81(1):19–23. doi: 10.1016/0002-9343(86)90176-2. [DOI] [PubMed] [Google Scholar]
  9. Gade W., Hinnefeld S. W., Babcock L. S., Gilligan P., Kelly W., Wait K., Greer D., Pinilla M., Kaplan R. L. Comparison of the PREMIER cryptococcal antigen enzyme immunoassay and the latex agglutination assay for detection of cryptococcal antigens. J Clin Microbiol. 1991 Aug;29(8):1616–1619. doi: 10.1128/jcm.29.8.1616-1619.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gray L. D., Roberts G. D. Experience with the use of pronase to eliminate interference factors in the latex agglutination test for cryptococcal antigen. J Clin Microbiol. 1988 Nov;26(11):2450–2451. doi: 10.1128/jcm.26.11.2450-2451.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hamilton J. R., Noble A., Denning D. W., Stevens D. A. Performance of cryptococcus antigen latex agglutination kits on serum and cerebrospinal fluid specimens of AIDS patients before and after pronase treatment. J Clin Microbiol. 1991 Feb;29(2):333–339. doi: 10.1128/jcm.29.2.333-339.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kovacs J. A., Kovacs A. A., Polis M., Wright W. C., Gill V. J., Tuazon C. U., Gelmann E. P., Lane H. C., Longfield R., Overturf G. Cryptococcosis in the acquired immunodeficiency syndrome. Ann Intern Med. 1985 Oct;103(4):533–538. doi: 10.7326/0003-4819-103-4-533. [DOI] [PubMed] [Google Scholar]
  13. Larsen R. A., Leal M. A., Chan L. S. Fluconazole compared with amphotericin B plus flucytosine for cryptococcal meningitis in AIDS. A randomized trial. Ann Intern Med. 1990 Aug 1;113(3):183–187. doi: 10.7326/0003-4819-113-3-183. [DOI] [PubMed] [Google Scholar]
  14. Saag M. S., Powderly W. G., Cloud G. A., Robinson P., Grieco M. H., Sharkey P. K., Thompson S. E., Sugar A. M., Tuazon C. U., Fisher J. F. Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. The NIAID Mycoses Study Group and the AIDS Clinical Trials Group. N Engl J Med. 1992 Jan 9;326(2):83–89. doi: 10.1056/NEJM199201093260202. [DOI] [PubMed] [Google Scholar]
  15. Weinke T., Rögler G., Sixt C., de Matos-Marques B., Pohle H. D., Staib F., Seibold M. Cryptococcosis in AIDS patients: observations concerning CNS involvement. J Neurol. 1989 Jan;236(1):38–42. doi: 10.1007/BF00314216. [DOI] [PubMed] [Google Scholar]
  16. Wu T. C., Koo S. Y. Comparison of three commercial cryptococcal latex kits for detection of cryptococcal antigen. J Clin Microbiol. 1983 Nov;18(5):1127–1130. doi: 10.1128/jcm.18.5.1127-1130.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Zuger A., Louie E., Holzman R. S., Simberkoff M. S., Rahal J. J. Cryptococcal disease in patients with the acquired immunodeficiency syndrome. Diagnostic features and outcome of treatment. Ann Intern Med. 1986 Feb;104(2):234–240. doi: 10.7326/0003-4819-104-2-234. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Microbiology are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES