Sensitivity and specificity of cryptococcal antigen lateral flow assay for the diagnosis of HIV-associated cryptococcal meningitis in western Kenya

Background: HIV-associated cryptococcal meningitis carries a high case-fatality-rate in sub-Saharan Africa. Diagnostic delays partly contribute to this. Rapid point-of-care tests may facilitate speedy diagnosis. This study aimed to determine the sensitivity and specificity of urine, serum and cerebrospinal fluid (CSF) cryptococcal antigen lateral flow assay for the diagnosis of HIV-associated cryptococcal meningitis compared with the gold standard CSF culture.Methods: A cross-sectional study was conducted in the medical wards of Moi Teaching and Referral Hospital, Eldoret, Kenya. Adult (≥18years) HIV-infected in-patients suspected to have meningitis had paired samples of urine, serum and CSF collected and tested real time using the cryptococcal antigen lateral flow assay (rapid point of care test). CSF cultures were also conducted. Data were analyzed using STATA ® (Statacorp Texas USA®). Descriptive statistics were used to summarize demographic, clinical and laboratory parameters. Sensitivity and specificity of the rapid test were calculated with the CSF culture as the gold standard.Results: Of the 302 participants included 172 (57%) were female, median age 37 years (IQR 30-45). The median CD4+ cell count was 183/ul (IQR 54-333). Among 288 participants with available CSF culture results, 50(17%) had culture-confirmed cryptococcal meningitis. Urine rapid test had a sensitivity and specificity of 86 %( 95% CI 73-94) and 95.7% (95% CI 92-98) respectively. Serum rapid test had a sensitivity and specificity of 92% (95%CI 81-98) and 94.9% (95%CI 91-97) respectively. CSF rapid test had a sensitivity and specificity of 92% (95%CI 81-98%) and 94.5% (95% CI 91-97) respectively. Conclusion: Serum and CSF cryptococcal antigen lateral flow assay are highly sensitive and specific for the diagnosis of HIV-associated cryptococcal meningitis. Urine is relatively sensitive and specific. Serum and CSF cryptococcal antigen lateral flow assay can be used as a less expensive alternative to cryptococcal antigen latex agglutination method. Urine cryptococcal antigen lateral flow assay could be adopted as a rapid point of care diagnostic test in primary care clinics in low income settings without experience in handling CSF or serum, to fast track diagnosis of cryptococcal meningitis

Prevalence and risk factors for hyperuricemia among patients with hypertension at Moi Teaching and Referral Hospital, Eldoret, Kenya

Objective: Uric acid, a mediator of high blood pressure, is an inexpensive easyto-obtain indicator of cardiovascular risk (stroke, myocardial infarction and renal disease). This study was conducted to determine the prevalence and risk factors for hyperuricemia among patients with hypertension in western Kenya.Methods: This cross-sectional study conducted at the Moi Teaching and Referral Hospital in western Kenya, enrolled randomly selected adults (≥ 18 years) with hypertension, attending medical outpatients’ clinic. Clinical (age, gender, stroke history, Body Mass Index, antihypertensive drugs and duration of illness) and laboratory (fasting lipid profile, blood sugar, uric acid and serum creatinine) data were collected. Data were keyed into Microsoft excel database and analyzed using STATA© version 13. Descriptive statistics were summarized using means, frequencies and proportions. Risk factors for hyperuricemia were analysed using two-sample t-tests, twosample Wilcoxon rank sum tests and Pearson’s Chi Square tests.Results: Of the 275 participants enrolled, 182 (66%) were female, mean age 54 (sd 12.5) years, mean Body Mass Index 28.9 (sd 4.9) and median duration of illness 6 months. Overall prevalence of hyperuricemia was 44%; with 37.6% and 47.3% in males and females respectively.Factors associated with hyperuricemia included high Body Mass Index (p 0.036), low Glomerular Filtration Rate (P<0.0001) and dyslipidemia (p<0.0001).Conclusion: There is a high prevalence of hyperuricemia among patients with hypertension in western Kenya. Risk factors associated with hyperuricemia include high Body Mass Index, dyslipidemia and low glomerular filtration rate. The use of losartan and calcium channel blockers is recommended in patients with hyperuricemia and  subsequent longitudinal studies to be done to determine utility of uric acid monitoring in blood pressure control.Keywords: Hypertension, Hyperuricemic Lipid Profile, Body Mass Index, Estimated Glomelular Filtration Rate (eGFR