Detection of cytomegalovirus DNA in cerebrospinal fluid in immunocompetent patients as a sign of active infection

1995 ◽  
Vol 46 (3) ◽  
pp. 274-280 ◽  
Author(s):  
M. Studahl ◽  
T. Bergström ◽  
K. Ekeland-Sjöberg ◽  
A. Ricksten
Keyword(s):  
Cerebrospinal Fluid ◽  
Active Infection ◽  
Immunocompetent Patients

scholarly journals Advances in Diagnosis of Progressive Pulmonary and Disseminated Coccidioidomycosis

2020 ◽  
Author(s):  
Christelle Kassis ◽  
Michelle Durkin ◽  
Eric Holbrook ◽  
Robert Myers ◽  
Lawrence Wheat
Keyword(s):  
Cerebrospinal Fluid ◽  
Retrospective Study ◽  
Medical Center ◽  
Antigen Detection ◽  
Antibody Detection ◽  
Main Method ◽  
System Sensitivity ◽  
Serum Antigen ◽  
Urine And Serum ◽  
Immunocompetent Patients

Abstract Background Antibody detection is the main method for diagnosis of coccidioidomycosis, but it has limitations. The Coccidioides antigen enzyme immunoassay is recommended for testing cerebrospinal fluid in suspected meningitis. Reports on urine and serum antigen detection evaluated small numbers of patients who were mostly immunocompromised. The purpose of this study was to assess the accuracy of combined antibody and antigen detection for diagnosis. Methods A retrospective study, including all patients in whom Coccidioides antigen detection in serum was performed between January 2013 and May 2017, was conducted at Valleywise Health Medical Center (formerly Maricopa Integrated Health System). Sensitivity and specificity of antigen and antibody were evaluated in 158 cases and 487 controls. Results The sensitivity of antibody detection by immunodiffusion (ID) was 84.2%. The sensitivity of antigen detection was 57.0% if both urine and serum were tested and 36.7% if urine alone was tested. The sensitivity of combining antigen and ID antibody detection was 93.0%. The sensitivity of urine and serum antigen detection was 55.4% in proven and 58.7% in probable cases, 79.1% in disseminated and 41.6% in pulmonary cases, and 74.7% in immunocompromised and 40.0% in immunocompetent patients. Specificity was 99.4% for antigen detection and 96.5% for ID antibody detection. Diagnostic accuracy was 95.4% for ID antibody and antigen detection, 93.6% for ID antibody alone, and 89.1% for pathology or culture. Conclusions These findings support combined antibody and antigen detection for diagnosis of progressive coccidioidomycosis. The diagnosis may have been missed if antigen detection was not performed.

scholarly journals The Upside of Bias

2016 ◽  
Vol 7 (1) ◽  
pp. 30-34 ◽  
Author(s):  
Christine Hessler ◽  
Carol A. Kauffman ◽  
Felicia C. Chow
Keyword(s):  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Sporothrix Schenckii ◽  
Empiric Therapy ◽  
Immunocompetent Patient ◽  
Unknown Etiology ◽  
Chronic Meningitis ◽  
Appropriate Treatment ◽  
Clinical And Functional Status ◽  
Immunocompetent Patients

Chronic meningitis of unknown etiology is a vexing illness for patients and clinicians. Identification of the correct pathogen can be challenging and time consuming, leading to delays in appropriate treatment. Although Sporothrix schenckii is a recognized and treatable cause of chronic meningitis, neurologists and infectious diseases physicians may not regularly evaluate for Sporothrix infection. We describe an immunocompetent patient with chronic meningitis who partially responded to empiric fluconazole. Prompted by a recent culture-confirmed case of meningeal sporotrichosis, we tested for S schenckii antibodies from the cerebrospinal fluid, which were positive. His clinical and functional status improved, and the S schenckii antibody titer decreased with itraconazole therapy. Clinicians should consider S schenckii in the differential diagnosis for chronic meningitis, even in immunocompetent patients, particularly when the clinical picture does not respond to standard empiric therapy.

scholarly journals Cryptococcal meningitis in apparently immunocompetent patients: association with idiopathic CD4+ lymphopenia

2017 ◽  
Vol 18 (2) ◽  
pp. 166-169 ◽  
Author(s):  
Samuel Shribman ◽  
Alastair Noyce ◽  
Sharmilee Gnanapavan ◽  
Jonathan Lambourne ◽  
Thomas Harrison ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Emergency Departments ◽  
Cryptococcal Antigen ◽  
Management Problems ◽  
Antigen Tests ◽  
Lymphocytic Meningitis ◽  
Immunocompetent Patients ◽  
Hiv Negative ◽  
New Onset

We present two cases of cryptococcal meningitis in people subsequently diagnosed with idiopathic CD4+ lymphopenia. Both presented with new onset headaches without sinister features and were sent home on multiple occasions from emergency departments. Cryptococcal meningitis in HIV-negative patients poses major diagnostic and management problems; the associated mortality is 9%–27%. We suggest performing blood and cerebrospinal fluid cryptococcal antigen tests in all people with lymphocytic meningitis.

scholarly journals Varicella Zoster Virus Meningitis with Absence of Rash in an Immunocompetent Child

2021 ◽  
Vol 2021 ◽  
pp. 1-2
Author(s):  
Mariam Lagrine ◽  
Karima El fakiri ◽  
Noureddine Rada ◽  
Ghizlane Draiss ◽  
Nabila Soraa ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Varicella Zoster Virus ◽  
Clinical Condition ◽  
Neurological Complications ◽  
Varicella Zoster ◽  
Immunocompetent Child ◽  
Hiv Test ◽  
Rapid Hiv Test ◽  
Immunocompetent Patients ◽  
Csf Examination

Only a few cases in the literature have ever reported the reactivation of the varicella zoster virus (VZV) in children especially in the case of immunocompetent patients. It is an uncommon situation that may lead to several neurological complications. We report varicella zoster virus (VZV) meningitis in a 14-year-old healthy boy with no antecedent of rash. On his cerebrospinal fluid (CSF) examination, VZV DNA was detected. The rapid HIV test was negative. The treatment using acyclovir (20 mg/kg/8h) was effective, and the child’s clinical condition rapidly improved.

scholarly journals Detection of Toxoplasma gondii soluble antigen, SAG-1(p30), antibody and immune complex in the cerebrospinal fluid of HIV positive or negative individuals

1999 ◽  
Vol 41 (6) ◽  
pp. 329-338 ◽  
Author(s):  
Flávia A. CHAVES-BORGES ◽  
Maria A. SOUZA ◽  
Deise A. O. SILVA ◽  
Lloyd H. KASPER ◽  
José R. MINEO
Keyword(s):  
Cerebrospinal Fluid ◽  
Immune Complexes ◽  
Clinical Findings ◽  
Toxoplasmic Encephalitis ◽  
Hiv Positive ◽  
Soluble Antigen ◽  
Active Infection ◽  
Toxoplasma Infection ◽  
Specific Igg ◽  
Major Surface

Active infection by T. gondii was evaluated by immunoassay for soluble SAG-1 (p30), the major surface antigen from T. gondii, specific antibodies and immune complexes in human cerebrospinal fluid (CSF) samples. A total of 263 samples of CSF were collected from hospitalized patients presenting neurological disorders and analyzed for antibodies to HIV. Patients were divided into two groups: HIV positive (n = 96) or HIV negative (n =167). The results of the assays showed that 45% of all samples were positive for soluble SAG-1. Toxoplasma Ag/Ab immune complexes were detected in 19% of the CSF samples and 62% were positive for T. gondii- specific IgG. A combination of these assays in the presence of clinical findings consistent with active Toxoplasma infection may predict the presence of toxoplasmic encephalitis. Moreover, detection of soluble SAG-1 in the CSF of these individuals appears consistent with active infection.

scholarly journals Disseminated Cryptococcosis Incorrectly Managed: a Case Report

2019 ◽  
pp. 28-31
Author(s):  
Adil Maleb ◽  
Aziza Hami ◽  
Yassine Ben Lahlou ◽  
Somiya Lamrabat ◽  
Safaa Rifai ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Blood Culture ◽  
Fungal Infection ◽  
Fatal Outcome ◽  
Microbiological Analysis ◽  
Immunocompromised Patients ◽  
Bacteriological Examination ◽  
Cryptococcal Infection ◽  
Immunocompetent Patients

Disseminated cryptococcosis is a rare fungal infection, which mainly occurs in immunocompromised patients, and the diagnosis is difficult. Therefore, it is less likely to be considered in immunocompetent patients. Here, we present a case of fatal cryptococcal infection of the pleural fluid and ascites in a patient seronegative for HIV. The patient was a 45-year old man who was followed for Crohn's disease and treated with steroids and an immunosuppressant (azathioprine). The culture of pleural and ascites fluids showed the presence of yeasts colonies identified as Cryptococcus neoformans. Bacteriological examination of the blood culture or cerebrospinal fluid (CSF) was not prescribed. The HIV serology was negative. At the fourth day of treatment, the patient died because of the deterioration of neurological and hepatocellular functions. The main diagnostic problems that led to this fatal outcome were non-suspicion of an at-risk patient, lack of microbiological analysis of the blood or CSF, and inadequate antifungal therapy.

scholarly journals Syphilitic meningitis presenting with multiple cranial neuropathies

2021 ◽  
Vol 14 (6) ◽  
pp. e241765
Author(s):  
Melissa Chu ◽  
Shejil Kumar ◽  
Jonathan Sturm
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Vascular Risk Factors ◽  
Early Initiation ◽  
Neurological Symptoms ◽  
Vascular Risk ◽  
Rapid Improvement ◽  
Cranial Neuropathies ◽  
Immunocompetent Patients ◽  
Csf Examination

Syphilis is increasingly prevalent in the community. The protean manifestations of neurosyphilis make the recognition, diagnosis and early initiation of treatment challenging. We report a case of early syphilitic meningitis presenting with multiple cranial neuropathies. Cerebrospinal fluid (CSF) examination was inflammatory with predominant lymphocytosis. The patient was diagnosed with neurosyphilis based on serum as well as CSF testing. Intravenous benzylpenicillin treatment resulted in rapid improvement of neurological symptoms. Neurosyphilis should be considered in immunocompetent patients presenting with multiple cranial neuropathies, or isolated cranial neuropathies without vascular risk factors.

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