3 years ago

Acridine orange fluorescent microscopy is more sensitive than India ink light microscopy in the rapid detection of cryptococcosis among CrAg positive HIV patients

David R. Boulware, Darlisha Williams, Andrew Akampurira, on behalf of the ASTRO-CM Study Team, David B. Meya, Richard Kwizera

by Richard Kwizera, Andrew Akampurira, Darlisha Williams, David R. Boulware, David B. Meya, on behalf of the ASTRO-CM Study Team

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.

Methods

We 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.

Results

Acridine 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.

Conclusion

Acridine orange is a better alternative to India ink in the rapid detection of cryptococcosis among CrAg positive HIV patients.

Publisher URL: http://journals.plos.org/plosone/article

DOI: 10.1371/journal.pone.0182108

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