Evaluation of five conventional and molecular approaches for diagnosis of cryptococcal meningitis in non‐HIV‐infected patients

Cryptococcal meningitis (CM) is a life‐threatening mycosis primarily occurring in HIV‐infected individuals. Recently, non‐HIV‐infected hosts were increasingly reported to form a considerable proportion. However, the majority of the reported studies on the diagnosis of CM patients were performed on HIV‐infected patients. For evaluation of various diagnostic approaches for CM in non‐HIV‐infected patients, a range of conventional and molecular assays used for diagnosis of CM were verified on 85 clinical CSFs from non‐HIV‐infected CM patients, including India ink staining, culture, a newly developed loop‐mediated isothermal amplification (LAMP), the lateral flow assay (LFA) of cryptococcal antigen detection and a qPCR assay. The LFA had the highest positive detection rate (97.6%; 95% CI, 91.8–99.7%) in non‐HIV‐infected CM patients, followed by the LAMP (87.1%; 95% CI, 78.0–93.4%), the qPCR (80.0%; 95% CI, 69.9–87.9%), India ink staining (70.6%; 95% CI, 59.7–80.0%) and culture (35.3%; 95% CI, 25.2–46.4%). All culture positive specimens were correctly identified by the LFA.