Diagnostic value of 4 different detection methods in human immunodeficiency virus infection complicated with cryptococcal meningitis

HU Wenjia; DENG Liping; LI Qian; CHEN Guo; ZHANG Zhongwei; YANG Rongrong; XIONG Yong

doi:10.3969/j.issn.1007-8134.2024.01.006

Abstract：Objective To explore the diagnostic value of cryptococcal antigen, India ink staining, fungal culture, and metagenomic next-generation sequencing ( mNGS ) of in cerebrospinal fluid ( CSF ) samples in HIV associated cryptococcal meningitis ( HIV-CM ). Method A retrospective analysis was conducted on the clinical data of 171 HIV/AIDS hospitalized patients with central nervous system infection who underwent lumbar puncture for cryptococcal testing in the Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, from December 2020 to December 2022. General information, clinical manifestations, and laboratory test results of HIV-CM patients were collected, and the positive rate, sensitivity, and specificity of the four detection methods for HIV-CM were compared. Results Among the 171 study subjects, a total of 35 patients were ultimately diagnosed with HIV-CM. The main manifestations of HIV-CM patients were neurological involvement, accompanied by fever, dizziness, and headache. Among 171 cerebrospinal fluid samples, the positive rate of CrAg detection was 18.9％, ink staining was 15.4％, fungal culture was 10.7％, and mNGS was 23.3％. The sensitivity of the CrAg detection, ink staining, fungal culture , and mNGS were 97.0％, 75.8％, 52.9％ and 100％, respectively, and the specificity were 100％, 99.3％, 100％ and 100％, respectively. The average reported time is 0.5 d, 0.5-1 d, 5 d and 2 d, respectively. The mNGS test results of 10 patients showed that up to 7 patients had multiple infections of three or more pathogenic bacteria simultaneously. Conclusions Ink staining of CSF samples can provide early screening for pathogenic diagnosis. Fungal culture is the gold standard for diagnosis, and subsequent drug sensitivity testing is needed. Cryptococcus antigen detection and mNGS have high sensitivity and specificity, and the detection report time is short. mNGS can be used for early pathogenic diagnosis of HIV patients with multiple infections. Therefore, it is recommended to combine various methods for simultaneous testing as much as possible to provide more accurate and rapid clinical evidence for the diagnosis of HIV-CM and to strive for greater benefits for patients.