Cryptococcal antigen

Fungal meningitis CSF culture, CSF and serum cryptococcal antigen titers, microscopic examination of CSF specimens... 

Cryptococcal antigen D-dimers Negative Less than 250 ng/mL 1 Less than 250 mcg/L... 

Examination of cerebrospinal fluid (CSF) in patients with cryptococcal meningitis generally reveals an elevated opening pressure, CSF pleocytosis (usually lymphocytes), leukocytosis, a decreased CSF glucose, an elevated CSF protein, and a positive cryptococcal antigen. 

Cryptococcal meningitis Lumbar puncture Serum Cryptococcal antigen (sCRAG) India-ink preparation Crypto Ag titer... 

Combination therapy with fluconazole (200 mg/day for 2 months) and flucytosine (150 mg/kg/day for the first 2 weeks n = 30) has been compared with fluconazole monotherapy (200 mg/day for 2 months n = 28) in a randomized open trial in Ugandan patients with AIDS-associated cryptococcal meningitis (12). Patients in both groups who survived for 2 months received maintenance therapy with fluconazole (200 mg three times per week for 4 months). There were no serious adverse events in any of the patients. The combination therapy prevented death within 2 weeks and significantly increased the survival rate at 6 months (32 versus 12%). However, the rate of positive cryptococcal antigen titers remained high at 2 months after treatment in both groups. 

Powderly WG, Cloud GA, Dismukes WE, Saag MS. Measurement of cryptococcal antigen in serum and cerebrospinal fluid Value in the management of AIDS-associated cryptococcal meningitis. Clin Infect Dis 1994 18 789-792. 

The CSF parameters in patients with AIDS are similar to those seen in non-AIDS patients, with the exception of a decreased inflammatory response to the pathogen, resulting in a strikingly low number of leukocytes in CSF and extraordinarily high cryptococcal antigen titers. 

For asymptomatic immunocompetent hosts with isolated pulmonary disease and no evidence of CNS disease, careful observation may be warranted in the case of symptomatic infection, fluconazole or amphotericin B is warranted (Table 119-5). In individuals with non-CNS cryptococcemia, a positive serum cryptococcal antigen titer (>1 8), cutaneous infection, a positive urine culture, or prostatic disease, the clinician must decide whether to follow the regimen for isolated pulmonary disease or the more aggressive regimen for patients with CNS (disseminated) disease. ... 

Goldman DL, Casadevall A, Zuckier LS. Pharmacokinetics and biodistribution of a monoclonal antibody to Cryptococcus neoformans capsular polysaccharide antigen in a rat model of cryptococcal meningitis implications for passive immunotherapy. J Med Vet Mycol 1997 35(4) 271-8. 

The standard diagnostic tests for fungal meningitis include culture, direct microscopic examination of stained and unstained specimens of CSF, antigen detection of cryptococcal or histoplasmal antigens, and antibody assay of serum and/or CSF. 

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