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Antigen, Cryptococcal

Cryptococcal Antigen Detection, Cryptococcus, Crypto, C. neoformans

Test Codes

CSF: EPIC: LAB6766, SERUM: EPIC: LAB6765

Department

Microbiology

Specimen Collection Criteria

Collect one of the following specimen types:

• CSF: 1.0 mL in a sterile collection container. (Minimum: 0.5 mL)
• Blood: One plain Red-top tube. (Minimum: 3.0 mL)

All requests for CSF Cryptococcal Antigen must have a CSF Culture ordered on the same specimen.
Transport specimen to the Laboratory immediately after collection.

Physician Office/Draw Specimen Preparation

• CSF: Maintain specimen at room temperature (20-26°C or 68-78.8°F) and arrange for STAT transportation to the Laboratory. Courier Services can be contacted for a STAT pickup at 1-800-551-0488. (Minimum CSF: 0.5 mL)
• Red-top tube: Let specimen clot for 30-60 minutes then immediately centrifuge to separate serum from cells. Transfer serum to a plastic transport tube and refrigerate (2-8°C or 36-46°F). (Minimum Serum: 0.5 mL)

Preparation for Courier Transport

Transport: CSF in a sterile collection container, at room temperature (20-26°C or 68-78.8°F), and/or serum, refrigerated (2-8°C or 36-46°F).

Rejection Criteria

• Hemolyzed specimens.
• Specimens with a volume of less than 0.5 mL.
• CSF specimens that are clotted or grossly bloody.
• Serum Separator (SST) tubes.

Inpatient Specimen Preparation

Farmington Hills, Grosse Pointe, Royal Oak and Troy

• Transport specimen STAT to the Microbiology laboratory.

Dearborn, Taylor, Trenton, Wayne

• Transport specimen STAT to the main laboratory. 

Storage

Specimen Stability for Testing:

CSF
Room Temperature (20-26°C or 68-78.8°F): 24 hours*
Refrigerated (2-8°C or 36-46°F): 7 days
Frozen (-20°C/-4°F or below): Unacceptable

*If ordered, CSF Culture must be set up immediately and prior to prolonged storage at refrigerator temperature.

Serum
Room Temperature (20-26°C or 68-78.8°F): 24 hours
Refrigerated (2-8°C or 36-46°F): 7 days
Frozen (-20°C/-4°F or below): Unacceptable

Specimen Storage in Department Prior to Disposal:

CSF: Refrigerated (2-8°C or 36-46°F): 30 days
Serum: Refrigerated (2-8°C or 36-46°F): 7 days 

Laboratory

Dearborn Microbiology Laboratory
Taylor, Trenton and Wayne sent to Dearborn Microbiology Laboratory for testing.

Royal Oak Microbiology Laboratory
Farmington Hills, Grosse Pointe and Troy sent to Royal Oak Microbiology Laboratory for testing.

Performed

Sunday – Saturday, 24 hours a day.
STAT results available within 1 hour of receipt in the Royal Oak Microbiology Laboratory.
Routine results available within 8 hours of receipt in the Royal Oak Microbiology Laboratory.

Reference Range

Negative.

Test Methodology

Latex Agglutination – Farmington Hills, Grosse Pointe, Royal Oak, Troy.

Enzyme Immunoassay – Dearborn, Taylor, Trenton, Wayne.

Interpretation

• If a physician suspects a cryptococcal infection due to clinical symptoms and a specimen gives a negative latex result, the specimen should be diluted and retested.
• Assay results must be evaluated in conjunction with other clinical and diagnostic findings. Trichosporon beigelli has been shown to produce a cross reactive polysaccharide antigen.
• The water of condensation (syneresis fluid) from culture media has been shown to agglutinate sensitized latex particles.
• Some persons with AIDS retain the CPS (cryptococcal polysaccharide) antigen for long periods of time. This is not due to active multiplication of the yeast. In these instances, subsequent specimen titration may assist the original laboratory findings concerning the prognosis of the disease.
• Persons with AIDS have shown serum antigen titer ranges from 1:2 to 1:32,678. The magnitude of the titer does not appear to correlate with the severity of infection but has been judged useful in the diagnosis of patients with widespread neurologic cryptococcal infection. However, titers greater than 1:10,000 in persons with AIDS are associated with 100% mortality.

Clinical Utility

The cryptococcal antigen test is a qualitative/semi-quantitative rapid test to detect the polysaccharide antigen associated with Cryptococcus neoformans infection.

Clinical Disease

• Initial cryptococcal infection begins by inhalation of the fungus into the lungs, usually followed by hematogenous spread to the brain and meninges. Involvement of the skin, bones, and joints may be seen. Cryptococcus neoformans is often cultured from the urine of patients with disseminated infections. In patients without human immunodeficiency virus infection, cryptococcosis, particularly cryptococcal meningitis, is usually seen in association with underlying conditions such as lupus erythematosus, sarcoidosis, leukemia, lymphomas, and Cushing's syndrome.
• Cryptococcosis is one of the defining diseases associated with AIDS. Patients with cryptococcosis and serologic evidence of human immunodeficiency virus infections are considered to have AIDS. In nearly 45% of AIDS patients, cryptococcosis was reported as the first AIDS-defining illness. Because none of the presenting signs or symptoms of cryptococcal meningitis (such as headache, fever, and malaise) are sufficiently characteristic to distinguish it from other infections that occur in patients with AIDS, determining cryptococcal antigen titers and culturing blood and cerebrospinal fluid are useful in making a diagnosis (1).

Epidemiology

Cryptococcus neoformans has been most frequently associated with aged pigeon (and other bird) droppings and soils contaminated with these droppings. The organism is usually not found in fresh droppings but is most evident in bird excreta that have accumulated over long periods on window ledges, vacant buildings, and other roosting sites.

Incubation Period

The incubation period, although not well defined, is probably a few weeks from the time of exposure (1).

Transmission

Acquisition is by inhalation of particles containing the organism. The fungus is not transmitted from person to person. Cryptococcus infects 5% to 10% of adults with AIDS but is less common in HIV-infected children (1).

Reference

1. Howell, S., K. Hazen, M.E. Brandt,. 2015. Candida, Cryptococcus, and Other Yeasts of Medical Importance. Jorgensen, J.H., et al. (eds.). Manual of Clinical Microbiology 11^th edition. ASM Press. Washington, D.C.

CPT Codes

86403
LOINC:  9819-4, c. neoformans/gattii 49098-7

Contacts

Last Updated

8/4/2021