Reproducibility of CSF quantitative culture methods for estimating rate of clearance in cryptococcal meningitis.

Medical Mycology
Jonathan DyalASTRO-CM Trial Team

Abstract

Quantitative cerebrospinal fluid (CSF) cultures provide a measure of disease severity in cryptococcal meningitis. The fungal clearance rate by quantitative cultures has become a primary endpoint for phase II clinical trials. This study determined the inter-assay accuracy of three different quantitative culture methodologies. Among 91 participants with meningitis symptoms in Kampala, Uganda, during August-November 2013, 305 CSF samples were prospectively collected from patients at multiple time points during treatment. Samples were simultaneously cultured by three methods: (1) St. George's 100 mcl input volume of CSF with five 1:10 serial dilutions, (2) AIDS Clinical Trials Group (ACTG) method using 1000, 100, 10 mcl input volumes, and two 1:100 dilutions with 100 and 10 mcl input volume per dilution on seven agar plates; and (3) 10 mcl calibrated loop of undiluted and 1:100 diluted CSF (loop). Quantitative culture values did not statistically differ between St. George-ACTG methods (P= .09) but did for St. George-10 mcl loop (P< .001). Repeated measures pairwise correlation between any of the methods was high (r≥0.88). For detecting sterility, the ACTG-method had the highest negative predictive value of 97% (91% St. George, 60% ...Continue Reading

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Citations

Mar 14, 2016·The Lancet Infectious Diseases·Joshua RheinUNKNOWN ASTRO-CM Study Team
Dec 13, 2016·Expert Review of Molecular Diagnostics·Matthew William McCarthy, Thomas J Walsh
Sep 28, 2018·Journal of Clinical Microbiology·Radha RajasinghamDavid R Boulware
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May 22, 2021·Infectious Disease Clinics of North America·Alexis C GushikenJohn W Baddley

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