Cryptococcosis other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Overview

Other diagnostic studies helpful for diagnosis of cryptococcal infection include demonstration of the budding yeast on India ink stain, staining the polysaccharide cell wall using mucicarmine stain, detection of cryptococcal antigen in CSF, and a positive culture for Cryptococcus neoformans.

Other Diagnostic studies

Culture

Microscopy

  • India Ink can be used on CSF to quickly visualize Cryptococcus cells under a microscope; however, it can have limited sensitivity.[2]
  • Many laboratories in the United States no longer perform this test. [3]
  • Histopathology for detection of narrow-based budding yeasts in tissue can also be used.[2]

Antigen detection

CSF Analysis

Cryptococcal meningitis may be differentiated from other causes of meningitis by cerebrospinal fluid examination as shown below:[4][5][6][7][8]

Cerebrospinal fluid level Normal level Bacterial meningitis[7] Viral meningitis[7] Cryptococcal meningitis Tuberculous meningitis[9] Malignant meningitis[4]
Cells/ul < 5 >300 10-1000 10-500 50-500 >4
Cells Lymphocyte:Monocyte 7:3 Granulocyte > Lymphocyte Lymphocyte > Granulocyte Lymphocyte > Granulocyte Lymphocytes Lymphocytes
Total protein (mg/dl) 45-60 Typically 100-500 Normal or slightly high High Typically 100-200 >50
Glucose ratio (CSF/plasma)[5] > 0.5 < 0.3 > 0.6 <0.3 < 0.5 <0.5
Lactate (mmols/l)[6] < 2.1 > 2.1 < 2.1 >3.2 > 2.1 >2.1
Others ICP:6-12 (cm H2O) CSF gram stain, CSF culture, CSF bacterial antigen PCR of HSV-DNA, VZV CSF gram stain, CSF india ink PCR of TBC-DNA CSF tumor markers such as alpha fetoproteins, CEA

Gallery


References

  1. Chechani V, Kamholz SL (1990). "Pulmonary manifestations of disseminated cryptococcosis in patients with AIDS". Chest. 98 (5): 1060–6. PMID 2225944.
  2. 2.0 2.1 2.2 2.3 2.4 Information for Healthcare Professionals about C. neoformans Infection. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/fungal/diseases/cryptococcosis-neoformans/health-professionals.html Accessed on December 31, 2015
  3. 3.0 3.1 3.2 Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed on December 31, 2015.
  4. 4.0 4.1 Le Rhun E, Taillibert S, Chamberlain MC (2013). "Carcinomatous meningitis: Leptomeningeal metastases in solid tumors". Surg Neurol Int. 4 (Suppl 4): S265–88. doi:10.4103/2152-7806.111304. PMC 3656567. PMID 23717798.
  5. 5.0 5.1 Chow E, Troy SB (2014). "The differential diagnosis of hypoglycorrhachia in adult patients". Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.
  6. 6.0 6.1 Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). "Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice". PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.
  7. 7.0 7.1 7.2 Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.
  8. Brouwer MC, Tunkel AR, van de Beek D (2010). "Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis". Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.
  9. Caudie C, Tholance Y, Quadrio I, Peysson S (2010). "[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]". Ann Biol Clin (Paris). 68 (1): 107–11. doi:10.1684/abc.2010.0407. PMID 20146981.
  10. 10.00 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 10.11 10.12 "Public Health Image Library (PHIL)".

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