Abstract

BackgroundIndia ink microscopy on cerebrospinal fluid is still utilized in resource limited settings for the diagnosis of cryptococcal meningitis despite its poor sensitivity. We hypothesized that staining fungal nucleic acids with fluorescent dyes instead of the capsule with India ink might improve sensitivity for the diagnosis of cryptococcal meningitis.MethodsWe enrolled 96 HIV-infected participants with cryptococcal meningitis who provided 194 CSF specimens at serial time points in Kampala, Uganda. Cryptococcosis was diagnosed by cerebrospinal fluid (CSF) cryptococcal antigen (CrAg) test and only positive samples were included. We stained CSF with India ink and acridine orange. We cultured the same samples on standard fungal media. We compared acridine orange to CrAg, India ink and CSF culture.ResultsAcridine orange was more sensitive (96%) than India ink (79%) with reference to CSF CrAg. Acridine orange and India ink had a statistically significant difference (P<0.001) with a 25% correlation for detection of Cryptococcus yeasts. India ink had more negative results (22%) than acridine orange (4%). The sensitivity for India ink increased (86%) while that of acridine orange did not change (97%) when compared to CSF culture. However, both India ink and acridine orange had poor predictive values with reference to culture.ConclusionAcridine orange is a better alternative to India ink in the rapid detection of cryptococcosis among CrAg positive HIV patients.

Highlights

  • Acridine orange is a better alternative to India ink in the rapid detection of cryptococcosis among cryptococcal antigen (CrAg) positive HIV patients

  • Cryptococcal meningitis (CM) is the most common cause of adult meningitis in Africa accounting for 15%–25% of AIDS-related deaths; with majority of the cases registered in subSaharan Africa [1,2,3,4]

  • Even though culture of cerebrospinal fluid (CSF) is still considered the gold standard for diagnosis of cryptococcal meningitis, recent evidence indicates that detection of the cryptococcal antigen (CrAg) in CSF has a better sensitivity [5, 6]

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Summary

Background

India ink microscopy on cerebrospinal fluid is still utilized in resource limited settings for the diagnosis of cryptococcal meningitis despite its poor sensitivity. We hypothesized that staining fungal nucleic acids with fluorescent dyes instead of the capsule with India ink might improve sensitivity for the diagnosis of cryptococcal meningitis

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