Evolution of Laboratory Diagnostics for Cryptococcosis and Missing Links to Optimize Diagnosis and Outcomes in Resource-Constrained Settings

Author:

Kwizera Richard12ORCID,Kiiza Tadeo K1,Akampurira Andrew12,Kimuda Sarah1,Mugabi Timothy1,Meya David B13

Affiliation:

1. Infectious Diseases Institute, College of Health Sciences, Makerere University , Kampala , Uganda

2. Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University , Kampala , Uganda

3. Department of Medicine, School of Medicine, College of Health Sciences, Makerere University , Kampala , Uganda

Abstract

Abstract Cryptococcal meningitis is one of the leading causes of death in sub-Saharan Africa among patients with advanced HIV disease. Early diagnosis is crucial in improving treatment outcomes. Despite advances and the availability of modern and point-of-care diagnostics for cryptococcosis, gaps still exist in resource-constrained settings, leading to unfavorable treatment outcomes. Here, we review the current outstanding issues or missing links that need to be filled to optimize the diagnosis of cryptococcosis in resource-constrained settings to improve treatment outcomes. We highlight the evolution of cryptococcosis diagnostics; the roles of early fungicidal activity, cryptococcal antigen titers, antifungal susceptibility testing, and therapeutic drug monitoring; and the missing links to optimize diagnosis and outcomes, including practical recommendations.

Funder

National Institute of Neurological Disorders and Stroke

Fogarty International Center

Publisher

Oxford University Press (OUP)

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