Evaluation of conventional & serological methods for rapid diagnosis of cryptococcosis.

ABSTRACT

BACKGROUND & OBJECTIVE: Cryptococcosis is a chronic infective condition affecting the central nervous system. Unless diagnosed early and specific treatment instituted it can be fatal. There is an urgent need for a rapid and specific diagnostic tool for better management of the patients. Conventional methods such as culture and India ink are specific but cumbersome and time consuming. Serological methods of detection are rapid but have problems of false positivity and cross-reactivity with other micro-organisms. We carried out this study to compare and evaluate the conventional methods with serological methods of detection of cryptococcal meningitis. METHODS: A comparative evaluation of conventional methods (India ink and culture) with LAT (latex agglutination test) and EIA (enzyme immunoassay) was done in 127 CSF samples using culture and EIA as reference separately. RESULTS: India ink was positive for Cryptococcus in 72.4 per cent of the samples; 56 per cent were culture positive; LAT positive were 85 per cent and 79.5 per cent were positive by EIA. When culture was positive, all other tests were in agreement to it. However, when culture was negative there was significant difference between the pair of discordance of various diagnostic tests. Culture was 83.46 per cent in agreement to India ink, 76.3 per cent to EIA and 70.8 per cent to LAT. EIA was 92.9 per cent in agreement to India ink and LAT; 6.3 per cent showed false positive by LAT. INTERPRETATION & CONCLUSION: EIA is valuable in establishing diagnosis when culture is negative for cryptococcosis. EIA is more specific and has potential advantages over LAT as it gives clear discrimination of positive from negative results. Thus, EIA may be used as a simple, rapid, and reliable serological test for early detection of cryptococcal antigen in clinical samples like CSF in routine laboratories.