Cryptococcosis other diagnostic studies: Difference between revisions

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Latest revision as of 21:10, 29 July 2020

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

India ink or fungal wet mount of CSF will demonstrate a budding yeast.
Mucicarmine stain provides specific staining of the polysaccharide cell wall.
Antigen detection in CSF is useful for the diagnosis of cryptococcal meningitis.
Cryptococcus neoformans can be cultured from sputum, bronchoalveolar lavage, transbronchial lung biopsy specimen, pleural fluid, or pleural biopsy specimen in patients with pulmonary cryptococcosis.^[1]

Culture

Culture is the gold standard for diagnosing cryptococcal infection.^[2]
Blood cultures may be positive in severe infections.

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

Antigen detection can be used on CSF or serum for detection of early, asymptomatic cryptococcal infection in HIV-infected patients.
It has a higher sensitivity than microscopy or culture.^[2]
CSF CrAg is usually positive in patients with cryptococcal meningoencephalitis. Serum CrAg is usually positive in both meningeal and non-meningeal infection and may be present weeks to months before symptom onset.^[3]
A positive serum CrAg should prompt a lumbar puncture to rule out meningeal disease.^[3]
Techniques used include:^[2]

Latex agglutination (LA)
Enzyme immunoassay (EIA)
Lateral flow assay (LFA)

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

Cryptococcosis of lung in patient with AIDS. From Public Health Image Library (PHIL). ^[10]
Cryptococcosis of lung in patient with AIDS. Mucicarmine stain. From Public Health Image Library (PHIL). ^[10]
Cryptococcosis of lung in patient with AIDS. Methenamine silver stain. From Public Health Image Library (PHIL). ^[10]
Micrograph depicts the histopathologic changes associated with cryptococcosis of the spleen. From Public Health Image Library (PHIL). ^[10]
Micrograph depicts the histopathologic changes associated with cryptococcosis of an adrenal gland. From Public Health Image Library (PHIL). ^[10]
Micrograph depicts the histopathologic changes associated with cryptococcosis of an adrenal gland. From Public Health Image Library (PHIL). ^[10]
Micrograph depicts the histopathologic changes associated with cryptococcosis of the lung using GMS stain. From Public Health Image Library (PHIL). ^[10]
Micrograph depicts the histopathologic changes associated with cryptococcosis of the lung using Mucicarmine stain. From Public Health Image Library (PHIL). ^[10]
Micrograph depicts histopathologic changes due to cryptococcosis of the liver. From Public Health Image Library (PHIL). ^[10]
Cryptococcus neoformans fungi from a liver specimen, and stained using the periodic acid-Schiff staining technique (980X mag). From Public Health Image Library (PHIL). ^[10]
Methenamine silver-stained photomicrograph of a lung lesion tissue specimen, reveals some morphology associated with the disease cryptococcosis (800X mag). From Public Health Image Library (PHIL). ^[10]
Photomicrograph of a lung lesion tissue specimen, reveals some morphology associated with the disease cryptococcosis (800x mag). From Public Health Image Library (PHIL). ^[10]
Periodic acid-Schiff-stained photomicrograph revealed some of the histopathologic details associated with a disseminated Cryptococcus sp. infection involving the liver (980x mag). From Public Health Image Library (PHIL). ^[10]

References

↑ Chechani V, Kamholz SL (1990). "Pulmonary manifestations of disseminated cryptococcosis in patients with AIDS". Chest. 98 (5): 1060–6. PMID 2225944.
↑ ^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
↑ ^3.0 ^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.
↑ ^4.0 ^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.
↑ ^5.0 ^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.
↑ ^6.0 ^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.
↑ ^7.0 ^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.
↑ 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.
↑ 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.
↑ ^10.00 ^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)".

[pmid2225944-1] Chechani V, Kamholz SL (1990). "Pulmonary manifestations of disseminated cryptococcosis in patients with AIDS". Chest. 98 (5): 1060–6. PMID 2225944.

[cdc-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

[aids-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.

[pmid23717798-4] 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.

[pmid24326618-5] 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.

[pmid22880096-6] 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.

[pmid10654948-7] 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.

[pmid20610819-8] 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.

[pmid20146981-9] 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.

[PHIL-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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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Cryptococcosis}}
+{{CMG}}; {{AE}} {{AKI}}
+==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 infection|cryptococcal]] [[antigen]] in [[CSF]], and a positive [[Culture media|culture]] for ''[[Cryptococcus neoformans]]''.
-==Overview==
 ==Other Diagnostic studies==
-*India ink or fungal wet mount of [[CSF]] will demonstrate a ([[Yeast|budding yeast]]).
+*India ink or [[Fungus|fungal]] wet mount of [[CSF]] will demonstrate a [[Yeast|budding yeast]].
-*[[Mucicarmine]] stain provides specific staining of the [[polysaccharide]] cell wall.
+*[[Mucicarmine]] stain provides specific staining of the [[polysaccharide]] [[cell wall]].
-*[[Antigen]] detection in [[CSF]] is useful for the diagnosis of cryptococcal meningitis.
+*[[Antigen]] detection in [[CSF]] is useful for the diagnosis of [[Cryptococcal Meningitis|cryptococcal meningitis]].
-*Broncho alveolar lavage can be done to culture the organism in patients with pulmonary cryptococcosis.<ref name="pmid2225944">{{cite journal| author=Chechani V, Kamholz SL| title=Pulmonary manifestations of disseminated cryptococcosis in patients with AIDS. | journal=Chest | year= 1990 | volume= 98 | issue= 5 | pages= 1060-6 | pmid=2225944 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2225944  }} </ref>
+*''[[Cryptococcus neoformans]]'' can be cultured from [[sputum]], [[bronchoalveolar lavage]], transbronchial lung [[biopsy]] specimen, [[pleural fluid]], or [[pleural]] [[biopsy]] specimen in patients with [[pulmonary]] [[cryptococcosis]].<ref name="pmid2225944">{{cite journal| author=Chechani V, Kamholz SL| title=Pulmonary manifestations of disseminated cryptococcosis in patients with AIDS. | journal=Chest | year= 1990 | volume= 98 | issue= 5 | pages= 1060-6 | pmid=2225944 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2225944  }} </ref>
+====Culture====
+*[[Culture media|Culture]] is the gold standard for diagnosing [[cryptococcal infection]].<ref name="cdc">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</ref>
+*[[Blood cultures]] may be positive in severe [[Infection|infections]].
+====Microscopy====
+*India Ink can be used on [[CSF]] to quickly visualize ''[[Cryptococcus neoformans|Cryptococcus]]'' cells under a microscope; however, it can have limited sensitivity.<ref name="cdc">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</ref>
+*Many laboratories in the United States no longer perform this test. <ref name="aids">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.</ref>
+*[[Histopathology]] for detection of narrow-based [[budding]] [[Yeast|yeasts]] in [[Tissue (biology)|tissue]] can also be used.<ref name="cdc">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</ref>
+====Antigen detection====
+* [[Antigen detection test|Antigen detection]] can be used on [[CSF]] or serum for detection of early, [[asymptomatic]] [[cryptococcal infection]] in [[HIV]]-infected patients.
+* It has a higher [[sensitivity]] than [[microscopy]] or culture.<ref name="cdc">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</ref>
+* [[CSF]] CrAg is usually positive in patients with [[Cryptococcosis|cryptococcal]] [[meningoencephalitis]]. [[Serum]] CrAg is usually positive in both [[meningeal]] and non-meningeal [[infection]] and may be present weeks to months before symptom onset.<ref name="aids">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.</ref>
+* A positive serum CrAg should prompt a [[lumbar puncture]] to rule out meningeal disease.<ref name="aids">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.</ref>
+*Techniques used include:<ref name="cdc">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</ref>
+:*[[Latex agglutination test|Latex agglutination]] (LA)
+:*[[Enzyme immunoassay]] (EIA)
+:*Lateral flow assay (LFA)
 ===CSF Analysis===
-Fungal meningitis may be differentiated from other causes of [[meningitis]] by [[cerebrospinal fluid]] examination as shown below:<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798  }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618  }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096  }} </ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }} </ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819  }} </ref>
+Cryptococcal meningitis may be differentiated from other causes of [[meningitis]] by [[cerebrospinal fluid]] examination as shown below:<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798  }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618  }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096  }} </ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }} </ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819  }} </ref>
-{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
+{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
 |+
 ! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Cerebrospinal fluid level}}
@@ Line 16: / Line 35: @@
 ! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Bacterial meningitis}}<ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }} </ref>
 ! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Viral meningitis}}<ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }} </ref>
-! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Fungal meningitis}}
+! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Cryptococcal meningitis}}
 ! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Tuberculous meningitis}}<ref name="pmid20146981">{{cite journal| author=Caudie C, Tholance Y, Quadrio I, Peysson S| title=[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]. | journal=Ann Biol Clin (Paris) | year= 2010 | volume= 68 | issue= 1 | pages= 107-11 | pmid=20146981 | doi=10.1684/abc.2010.0407 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20146981  }} </ref>
 ! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Malignant meningitis}}<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798  }} </ref>
@@ Line 32: / Line 51: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |'''[[Granulocyte]] > [[Lymphocyte]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Granulocyte]]'''
-| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte|Lympho]].>[[Granulocyte]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Granulocyte]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte|Lymphocytes]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte|Lymphocytes]]'''
@@ Line 74: / Line 93: @@
 <gallery>
-Image: Cryptococcosis21.jpeg| Cryptococcosis of lung in patient with AIDS. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
+Image: Cryptococcosis21.jpeg| Cryptococcosis of lung in patient with [[AIDS]]. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
-Image: Cryptococcosis20.jpeg| Cryptococcosis of lung in patient with AIDS. Mucicarmine stain. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
+Image: Cryptococcosis20.jpeg| Cryptococcosis of lung in patient with [[AIDS]]. Mucicarmine stain. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
-Image: Cryptococcosis19.jpeg| Cryptococcosis of lung in patient with AIDS. Methenamine silver stain. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
+Image: Cryptococcosis19.jpeg| Cryptococcosis of lung in patient with [[AIDS]]. Methenamine silver stain. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
 Image: Cryptococcosis18.jpeg| Micrograph depicts the histopathologic changes associated with cryptococcosis of the spleen. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
 Image: Cryptococcosis17.jpeg| Micrograph depicts the histopathologic changes associated with cryptococcosis of an adrenal gland. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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 [[Category:Fungal diseases]]
 [[Category:Disease]]
+[[Category:Emergency medicine]]
+[[Category:Up-To-Date]]
+[[Category:Infectious disease]]
+[[Category:Pulmonology]]
+[[Category:Neurology]]
+[[Category:Dermatology]]