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 Symptomatic Cryptococcal Meningitis with Negative Serum and Cerebrospinal Fluid Cryptococcal Antigen Tests

2021 ◽  
Vol Volume 13 ◽  
pp. 861-865
Author(s):  
Vivien Nanfuka ◽  
Mkhoi L Mkhoi ◽  
Jane Gakuru ◽  
Richard Kwizera ◽  
Joseph Baruch Baluku ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Cryptococcal Antigen ◽  
Antigen Tests

scholarly journals LATERAL FLOW ASSAY FOR CRYPTOCOCCAL ANTIGEN: AN IMPORTANT ADVANCE TO IMPROVE THE CONTINUUM OF HIV CARE AND REDUCE CRYPTOCOCCAL MENINGITIS-RELATED MORTALITY

2015 ◽  
Vol 57 (suppl 19) ◽  
pp. 38-45 ◽  
Author(s):  
Jose E. VIDAL ◽  
David R. BOULWARE
Keyword(s):  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Capsular Polysaccharide ◽  
Lateral Flow ◽  
Lateral Flow Assay ◽  
World Health ◽  
Hiv Care ◽  
Analytical Sensitivity ◽  
Symptomatic Infection ◽  
Cryptococcal Antigen

SUMMARYAIDS-related cryptococcal meningitis continues to cause a substantial burden of death in low and middle income countries. The diagnostic use for detection of cryptococcal capsular polysaccharide antigen (CrAg) in serum and cerebrospinal fluid by latex agglutination test (CrAg-latex) or enzyme-linked immunoassay (EIA) has been available for over decades. Better diagnostics in asymptomatic and symptomatic phases of cryptococcosis are key components to reduce mortality. Recently, the cryptococcal antigen lateral flow assay (CrAg LFA) was included in the armamentarium for diagnosis. Unlike the other tests, the CrAg LFA is a dipstick immunochromatographic assay, in a format similar to the home pregnancy test, and requires little or no lab infrastructure. This test meets all of the World Health Organization ASSURED criteria (Affordable, Sensitive, Specific, User friendly, Rapid/robust, Equipment-free, and Delivered). CrAg LFA in serum, plasma, whole blood, or cerebrospinal fluid is useful for the diagnosis of disease caused by Cryptococcusspecies. The CrAg LFA has better analytical sensitivity for C. gattii than CrAg-latex or EIA. Prevention of cryptococcal disease is new application of CrAg LFA via screening of blood for subclinical infection in asymptomatic HIV-infected persons with CD4 counts < 100 cells/mL who are not receiving effective antiretroviral therapy. CrAg screening of leftover plasma specimens after CD4 testing can identify persons with asymptomatic infection who urgently require pre-emptive fluconazole, who will otherwise progress to symptomatic infection and/or die.

scholarly journals Point-of-Care Diagnosis and Prognostication of Cryptococcal Meningitis With the Cryptococcal Antigen Lateral Flow Assay on Cerebrospinal Fluid

2013 ◽  
Vol 58 (1) ◽  
pp. 113-116 ◽  
Author(s):  
Taseera Kabanda ◽  
Mark J. Siedner ◽  
Jeffrey D. Klausner ◽  
Conrad Muzoora ◽  
David R. Boulware
Keyword(s):  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Point Of Care ◽  
Lateral Flow ◽  
Lateral Flow Assay ◽  
Cryptococcal Antigen

scholarly journals Cryptococcal Antigen in Serum and Cerebrospinal Fluid for Detecting Cryptococcal Meningitis in Adults Living With Human Immunodeficiency Virus: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies

2020 ◽  
Author(s):  
Elvis Temfack ◽  
Jean Joel Bigna Rim ◽  
Rene Spijker ◽  
Angela Loyse ◽  
Tom Chiller ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cerebrospinal Fluid ◽  
Sensitivity And Specificity ◽  
Antifungal Therapy ◽  
Cryptococcal Meningitis ◽  
Meta Analysis ◽  
Test Accuracy ◽  
Fungal Culture ◽  
Cryptococcal Antigen ◽  
Immunodeficiency Virus

Abstract Cryptococcal antigen (CrAg) detection could direct the timely initiation of antifungal therapy. We searched MEDLINE and Embase for studies where CrAg detection in serum/cerebrospinal fluid (CSF) and CSF fungal culture were done on adults living with human immunodeficiency virus (HIV) who had suspected cryptococcal meningitis (CM). With Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), we evaluated the risk of bias in 11 included studies with 3600 participants, and used a random-effects meta-analysis to obtain summary sensitivity and specificity of serum and CSF CrAg, as well as agreement between CSF CrAg and CSF culture. Summary sensitivity and specificity of serum CrAg were 99.7% (97.4–100) and 94.1% (88.3–98.1), respectively, and summary sensitivity and specificity of CSF CrAg were 98.8% (96.2–99.6) and 99.3% (96.7–99.9), respectively. Agreement between CSF CrAg and CSF culture was 98% (97–99). In adults living with HIV who have CM symptoms, serum CrAg negativity may rule out CM, while positivity should prompt induction antifungal therapy if lumbar puncture is not feasible. In a first episode of CM, CSF CrAg positivity is diagnostic.

Cerebrospinal fluid 14-3-3-γ protein level in eight HIV-negative cryptococcal meningitis adults

2008 ◽  
Vol 15 (4) ◽  
pp. 428-430 ◽  
Author(s):  
W. N. Chang ◽  
C. H. Lu ◽  
C. R. Huang ◽  
Y. C. Chuang ◽  
N. W. Tsai ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Protein Level ◽  
Cryptococcal Meningitis ◽  
Hiv Negative

scholarly journals The clinical profiles and outcomes of HIV-negative cryptococcal meningitis patients in type II diabetes mellitus

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hang Li ◽  
Xiaojing Li ◽  
Lei Zhang ◽  
Wenjie Fang ◽  
Keming Zhang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Type Ii Diabetes ◽  
Type Ii Diabetes Mellitus ◽  
Nausea And Vomiting ◽  
Type Ii ◽  
Clinical Profiles ◽  
Visual Disorders ◽  
Hiv Negative

Abstract Background The clinical profiles and outcomes of cryptococcal meningitis have been shown to vary depending on the underlying condition. The aim of this study was to investigate clinical characteristics and outcomes in patients with and without type II diabetes mellitus. Methods A retrospective study was performed. Clinical data of HIV-negative cryptococcal meningitis patients with type II diabetes mellitus (n = 26) and without type II diabetes mellitus (n = 52) referring to the Jiangxi Chest Hospital between January 2012 to December 2018 were analyzed. The data were analyzed using chi square, none-parametric tests, and logistic regression. P-values < 0.05 were considered significant. Results In this study, cryptococcal meningitis patients suffering from type II diabetes mellitus had a higher mortality (23.08% vs. 7.69%; P = 0.055), and required longer hospitalization (59.58 vs. 42.88 days; P = 0.132). Moreover, cerebrospinal fluid examinations revealed that cryptococcal meningitis patients with type II diabetes mellitus had higher opening pressure (271.54 vs. 234.23 mmH2O; P = 0.125).The results of multivariate regression analysis revealed that cryptococcal meningitis patients with type II diabetes were more often presented with visual disorders (28.54% vs. 11.54%; [95% CI 0.056–0.705]; p = 0.012), and had higher cerebrospinal fluid protein levels (1027.62 ± 594.16 vs. 705.72 ± 373.88 mg/l; [95% CI 1.000–1.002]; p = 0.016). Among patients with type II diabetes mellitus, nausea and vomiting was more frequent at the initial visit in those died (100% vs. 50%; p = 0.027), and 66% of died type II diabetes mellitus patients were poorly controlled blood glucose level, compared with 30% in survival type II diabetes mellitus patients. Conclusion This study suggests that cryptococcal meningitis patients with type II diabetes mellitus differ significantly from cryptococcal meningitis patients without type II diabetes mellitus with respect to clinical symptoms such as visual disorders and cerebrospinal fluid examination. The presence of nausea and vomiting among type II diabetes mellitus patients could have implication in mortality.

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