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Trop Med Infect Dis. 2018 Dec 20;4(1). pii: E1. doi: 10.3390/tropicalmed4010001.

Cryptococcus neoformans: Diagnostic Dilemmas, Electron Microscopy and Capsular Variants.

Author information

1
National Institute for Communicable Diseases-a Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham 2192, South Africa. monicab@nicd.ac.za.
2
National Institute for Communicable Diseases-a Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham 2192, South Africa. serishan@nicd.ac.za.
3
School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa. serishan@nicd.ac.za.
4
National Institute for Communicable Diseases-a Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham 2192, South Africa. nozukob@nicd.ac.za.
5
National Institute for Communicable Diseases-a Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham 2192, South Africa. ivyr@nicd.ac.za.
6
National Institute for Communicable Diseases-a Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham 2192, South Africa. junot@nicd.ac.za.
7
School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa. junot@nicd.ac.za.
8
National Institute for Communicable Diseases-a Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham 2192, South Africa. CharlotteS@nicd.ac.za.
9
School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa. CharlotteS@nicd.ac.za.
10
National Health Laboratory Service, Port Elizabeth Provincial Hospital, Cnr Buckingham & Eastbourne Road, Port Elizabeth 6001, South Africa. Shareef.Abrahams@nhls.ac.za.
11
National Health Laboratory Service, Tambo Memorial Hospital, Cnr Hospital & Railway Street, Boksburg 1459, South Africa. grisselda.mavuso@nhls.ac.za.
12
National Institute for Communicable Diseases-a Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham 2192, South Africa. neleshg@nicd.ac.za.
13
School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa. neleshg@nicd.ac.za.

Abstract

Two cases of cryptococcal meningitis went undetected by a cryptococcal antigen (CrAg) lateral flow assay on blood in a reflex CrAg screen-and-treat programme in South Africa, although Cryptococcus neoformans was identified by culturing the cerebrospinal fluid specimens. Further investigations into these discordant diagnostic results included multilocus sequence typing (which showed no mutations in the CAP59 gene) and transmission electron microscopy using a capsule-staining protocol (which revealed a >50% reduction in capsular material in both cases, relative to a control culture). A multi-disciplinary approach for resolving discordant diagnostic test results is recommended.

KEYWORDS:

Cryptococcus neoformans; capsule; lateral flow assay; molecular characterisation; transmission electron microscopy

PMID:
30577542
DOI:
10.3390/tropicalmed4010001
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