Evolution of laboratory diagnostics for cryptococcosis and missing links to optimize diagnosis and outcomes in resource-constrained settings

Abstract

Cryptococcal meningitis is one of the leading causes of death in sub-Saharan Africa among advanced HIV disease patients. 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 role of early fungicidal activity, CrAg titres, antifungal susceptibility testing, therapeutic drug monitoring and the missing links to optimize diagnosis and outcomes, including some practical recommendations.