Neglecting Genetic Diversity Hinders Timely Diagnosis of <i>Cryptococcus</i> Infections
Dongmei Shi, Pieter‐Jan Haas, Teun Boekhout, Rosane Christine Hahn, Ferry Hagen
Abstract
More than a decade ago, the first cryptococcal lateral flow assay (LFA) became available. This affordable point-of-care test has undeniably led to tremendous improvements in early detection of cryptococcosis (1, 2). However, from several studies, it must be concluded that the reliability of recently introduced assays falls short, thereby negatively impacting timely detection and thus hindering an effective treatment of cryptococcal infections (3–6). The apparent reduced performance of newly commercialized cryptococcal LFAs might be caused by ignoring the genetic diversity as manufacturers focus on the four serotypes A to D. Whereas the first commercially available cryptococcal LFA (IMMY Diagnostics, Norman, OK, USA) was extensively evaluated (1, 7), this does not seem to be the case with LFAs from other manufacturers in that their product information indicates that only one strain per serotype was used for product development. The observation of neglecting the genetic diversity within the Cryptococcus gattii/Cryptococcus neoformans species complexes, combined with reports of false-negative LFAs not related to the pro-/postzone effect (8–10), inspired us to compare commercially available LFAs with a set of well-defined strains that reflects the genetic diversity within the C. gattii/C. neoformans species complexes.