[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-446546-105":59,"doc-detail-446546-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","phasing-out-india-ink-the-case-for-the-crag-lfa-in-modern-practice","Phasing out India ink - the case for the CrAg LFA in modern practice","","Cryptococcal meningitis remains a life-threatening infection, especially among immunocompromised patients, making timely and accurate diagnosis critical. A retrospective review of 489 cerebrospinal fluid samples at a tertiary cancer center found India ink staining had low sensitivity (42.9%) versus lateral flow antigen (100%) and multiplex PCR (100%). Results support replacing the outdated, labor-intensive India ink test with faster, more accurate diagnostics to improve detection and patient outcomes.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/phasing-out-india-ink-the-case-for-the-crag-lfa-in-modern-practice/446546/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/phasing-out-india-ink-the-case-for-the-crag-lfa-in-modern-practice/446546.png","ImageObject",300,407,{"name":92,"@type":93},"supergirl","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is timely diagnosis of cryptococcal meningitis emphasized?","Question",{"text":113,"@type":114},"Cryptococcal meningitis is life-threatening and diagnosis is essential for prompt treatment, particularly in immunocompromised patients. The document stresses that delays or missed diagnoses worsen outcomes.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What did the study find about the sensitivity of India ink staining?",{"text":118,"@type":114},"In a retrospective review, India ink staining showed low sensitivity of 42.9% compared with lateral flow antigen (100%) and multiplex PCR (100%). The document also notes that sensitivity in their cohort was lower than the commonly cited range.",{"name":120,"@type":111,"acceptedAnswer":121},"What tests were compared to evaluate the current role of India ink?",{"text":122,"@type":114},"The document compares India ink staining with the cryptococcal antigen lateral flow assay (CrAg LFA) and a multiplex meningitis/encephalitis PCR panel, alongside fungal culture as the gold standard for sensitivity and specificity calculations.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},446546,1791313188,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52,"preview_page_count":4},962088121634,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","| Clinical Microbiology | Observation  \nPhasing out India ink: the case for the CrAg LFA in modern practice  \nSejal Morjaria,1 Derick Iturralde,2 Brenden Clarck,2 N. Esther Babady1,2 AUTHOR AFFILIATIONS See affiliation list on p. 4.  \nABSTRACT Cryptococcal meningitis remains a life-threatening infection, particularly in immunocompromised patients, and timely, accurate diagnosis is essential. In a retrospective review of 489 cerebrospinal fluid samples at a tertiary cancer center, the India ink stain demonstrated low sensitivity (42.9%) compared to lateral flow antigen (100%) and multiplex PCR (100%) methods. These findings support replacing the outdated, labor-intensive India ink test with more accurate, rapid diagnostics to improve detection and patient outcomes.  \nIMPORTANCE The India ink test has historically been a cornerstone of cryptococcal diagnosis, but its low sensitivity and reliance on subjective interpretation make it increasingly obsolete in modern practice. Continued reliance on India ink risks delayed or missed diagnoses, particularly in immunocompromised patients where early detection is critical. In contrast, the cryptococcal antigen lateral flow assay (CrAg LFA) and other modern diagnostics provide superior sensitivity, ease of use, and reproducibility. Phasing out India ink in favor of the CrAg LFA is essential to align clinical practice with contemporary diagnostic standards and to improve patient outcomes.  \nKEYWORDS diagnostic stewardship, microbiology  \nC ryptococcal meningitis is a serious fungal infection of the central nervous system  \ncaused by Cryptococcus neoformans. It carries a high mortality risk, especially in immunocompromised individuals (both HIV and cancer patients) if not promptly diagnosed and treated (1, 2) . The use of India ink for the diagnosis of Cryptococcus spp. has long been a standard diagnostic tool in microbiology laboratories (3, 4) . However, this method is increasingly being replaced due to advances in diagnostic technology, such as the cryptococcal antigen lateral flow assay (CrAg LFA), and molecular multiplex meningitis/encephalitis (M/E) panels (BioFire) . The India ink stain highlights the capsule of Cryptococcus and requires a trained medical laboratory scientist to prepare and interpret the sample, with accuracy heavily dependent on the examiner’s skill and subject to interobserver variability (5) . Additionally, the India Ink test typically requires a high fungal burden (>1,000 CFU/mL) for detection, increasing the risk of errors such as false negatives (6, 7) . Consequently, the India ink test has relatively low sensitivity, ranging from 50% to 80%, and may fail to detect Cryptococcus infection, especially in cases when the fungal burden is low (8–10) . Despite these limitations, India Ink remains in routine use at many institutions, including our own at Memorial Sloan Kettering Cancer Center, and it continues to be featured in proficiency testing challenges by the College of American Pathologists (11) .  \nTo better understand the current role of this assay, we evaluated its clinical performance in our laboratory. We evaluated the clinical utility of India ink staining by reviewing its performance in our laboratory between January 2018 and August 2024. During this period, 457 cerebrospinal fluid (CSF) samples from 439 patients were tested for  \nEditor Rebecca Yee, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA  \nAddress correspondence to N. Esther Babady, [babadyesther@gmail.com](babadyesther@gmail.com).  \ncryptococcal infection using India ink stain, CrAg LFA, fungal culture, and M/E multiplex PCR panel. The CrAg LFA was performed using the IMMY CrAg LFA kit (Immuno-Mycologics, Norman, OK) according to the manufacturer’s instructions. Briefly, CSF specimens were mixed with specimen diluent, and a lateral flow strip was inserted; results were read visually at 10 minutes. Semiquantitative titers were obtained by serial two","cbCaipNoWG9Ho1HK","https://ap.wps.com/l/cbCaipNoWG9Ho1HK","pdf",200868,"English","# Observation\n# Abstract\n# Importance\n# Methods and Clinical Performance\n## CrAg LFA testing\n## India ink vs LFA vs multiplex PCR results","[{\"question\":\"Why is timely diagnosis of cryptococcal meningitis emphasized?\",\"answer\":\"Cryptococcal meningitis is life-threatening and diagnosis is essential for prompt treatment, particularly in immunocompromised patients. The document stresses that delays or missed diagnoses worsen outcomes.\"},{\"question\":\"What did the study find about the sensitivity of India ink staining?\",\"answer\":\"In a retrospective review, India ink staining showed low sensitivity of 42.9% compared with lateral flow antigen (100%) and multiplex PCR (100%). The document also notes that sensitivity in their cohort was lower than the commonly cited range.\"},{\"question\":\"What tests were compared to evaluate the current role of India ink?\",\"answer\":\"The document compares India ink staining with the cryptococcal antigen lateral flow assay (CrAg LFA) and a multiplex meningitis/encephalitis PCR panel, alongside fungal culture as the gold standard for sensitivity and specificity calculations.\"}]","Phasing out India ink - the case for the CrAg LFA in modern practice | PDF",1790715883]