{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T19:03:33Z","timestamp":1785438213080,"version":"3.56.0"},"reference-count":21,"publisher":"American Society for Microbiology","issue":"2","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["CDC-RFA-GH15-1575"],"award-info":[{"award-number":["CDC-RFA-GH15-1575"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI118511"],"award-info":[{"award-number":["R01AI118511"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2026,2,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>While South African guidelines recommend a lumbar puncture (LP) to exclude cryptococcal meningitis (CM) among all people with a newly positive cryptococcal antigen (CrAg) test, irrespective of CM symptoms, this is not always feasible. High blood CrAg lateral flow assay (LFA) titers are associated with concurrent CM and increased mortality. Single-strip CrAg semi-quantitative (SQ) tests could risk-stratify people with antigenemia. Consecutive fresh LFA-positive remnant plasma samples from a CD4 laboratory network collected between April and July 2021 were retested. We described LFA titers, CrAgSQ scores, and the proportion with cerebrospinal fluid (CSF) collected 28 days before or after a positive CrAg screening test. Of 2,240 re-tested plasma samples from unique patients, 2,166 (97%) were confirmed LFA-positive. The median LFA titer was 640 (IQR, 40\u20135,120), 63% (1,354\/2,166) had a titer of \u2265160, and 52% (1,124\/2,166) had SQ scores of \u22653+. Only 31% (662\/2,166) had a CSF sample collected 28 days before or after a CrAg LFA-positive test; 60% (398\/662) had confirmed CM. More than half of the people with cryptococcal antigenemia had a blood CrAg titer of \u2265160 or a CrAgSQ score of \u22653+, both previously shown to confer a high risk of concurrent CM. Of 3 in 10 who had an LP, most had CM, suggesting that meningitis symptoms prompted LP. Healthcare worker support\/training is required to improve adherence to the universal LP recommendation. When immediate LP is not feasible, blood CrAgSQ testing can rapidly identify people at the highest risk of CM who require urgent referral for LP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>A majority of patients with HIV-associated cryptococcal antigenemia identified through a large screening program in South Africa had high cryptococcal antigen titers and thus an elevated risk of concurrent meningitis and death. Despite this, a relatively small proportion had a lumbar puncture to definitively exclude meningitis. Routine CrAg semi-quantification can help to stratify patients at higher risk for meningitis and guide clinicians\u2019 management, but performing a full range of titers for all CrAg-positive blood samples increases costs and is labor-intensive. An alternative approach is to use a single test strip, which yields a semi-quantitative score.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/jcm.00886-25","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T14:00:36Z","timestamp":1768485636000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":2,"title":["Cryptococcal antigen titers and semi-quantitative assay scores among people with HIV-associated cryptococcal antigenemia"],"prefix":"10.1128","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9258-0273","authenticated-orcid":true,"given":"Tshiama M.","family":"Mwamba","sequence":"first","affiliation":[{"name":"Wits Mycology Division, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand","place":["Johannesburg, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nozuko P.","family":"Blasich","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/007wwmx82","id-type":"ROR","asserted-by":"publisher"}],"name":"Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service","place":["Johannesburg, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8981-1744","authenticated-orcid":true,"given":"Lindi M.","family":"Coetzee","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00znvbk37","id-type":"ROR","asserted-by":"publisher"}],"name":"National Priority Programmes CD4 Unit, National Health Laboratory Service","place":["Johannesburg, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3228-7096","authenticated-orcid":true,"given":"Rudzani","family":"Mashau","sequence":"additional","affiliation":[{"name":"Wits Mycology Division, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand","place":["Johannesburg, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7869-9462","authenticated-orcid":true,"given":"Nelesh P.","family":"Govender","sequence":"additional","affiliation":[{"name":"Wits Mycology Division, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand","place":["Johannesburg, South Africa"]},{"id":[{"id":"https:\/\/ror.org\/007wwmx82","id-type":"ROR","asserted-by":"publisher"}],"name":"Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service","place":["Johannesburg, South Africa"]},{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"Division of Medical Microbiology, University of Cape Town","place":["Rondebosch, South Africa"]},{"id":[{"id":"https:\/\/ror.org\/047ybhc09","id-type":"ROR","asserted-by":"publisher"}],"name":"Institute of Infection and Immunity, City St George\u2019s University of London","place":["London, United Kingdom"]},{"id":[{"id":"https:\/\/ror.org\/00vbzva31","id-type":"ROR","asserted-by":"publisher"}],"name":"MRC Centre for Medical Mycology, University of Exeter","place":["Exeter, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.4102\/sajhivmed.v20i1.1030"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01238-18"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix872"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ936"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.15-0857"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-198902000-00004"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2010.03.015"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofv046"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa356"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00441-20"},{"key":"e_1_3_4_12_2","first-page":"197","article-title":"Cryptococcal antigen screening surveillance report, South Africa, February 2017-July 2019","volume":"17","author":"Greene G","year":"2019","unstructured":"Greene G, Desanto D, Matlapeng P, Govender N. 2019. Cryptococcal antigen screening surveillance report, South Africa, February 2017-July 2019. NICD Bull 17:197\u2013206. https:\/\/www.nicd.ac.za\/wp-content\/uploads\/2019\/12\/CRYPTOCOCCAL-ANTIGEN-SCREENING-SURVEILLANCE-NICD-Bulletin-Vol17-Iss3-December2019.pdf.","journal-title":"NICD Bull"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1590\/S0036-46652015000700008"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02046-19"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00860-21"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1037\/h0026256"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1086\/597262"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix613"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001561"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2022.115082"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.20-0509"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/trstmh\/trab124"}],"container-title":["Journal of Clinical Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/jcm.00886-25","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/jcm.00886-25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T14:01:11Z","timestamp":1770818471000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/jcm.00886-25"}},"subtitle":[],"editor":[{"given":"Kimberly E.","family":"Hanson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,11]]},"references-count":21,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2,11]]}},"alternative-id":["10.1128\/jcm.00886-25"],"URL":"https:\/\/doi.org\/10.1128\/jcm.00886-25","relation":{},"ISSN":["0095-1137","1098-660X"],"issn-type":[{"value":"0095-1137","type":"print"},{"value":"1098-660X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,11]]},"assertion":[{"value":"2025-06-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00886-25"}}