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Volume 42, Number 3, June 2009

Cryptococcal disease in patients with or without human immunodeficiency virus: clinical presentation and monitoring of serum cryptococcal antigen titers


Te-Yu Lin, Kuo-Ming Yeh, Jung-Chung Lin, Ning-Chi Wang, Ming-Yieh Peng, Feng-Yee Chang
Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Received: April 11, 2008    Revised: June 29, 2008    Accepted: July 22, 2008   

 

Corresponding author:

Dr. Feng-Yee Chang, Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan. E-mail: Dr. Feng-Yee Chang This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
 



 

Background and purpose: 

Cryptococcus neoformans is an encapsulated pathogenic yeast that causes a wide range of clinical manifestations. The serum cryptococcal latex agglutination test is a simple, rapid, and reliable diagnostic test for cryptococcosis. This study was performed to assess the clinical relevance of serum cryptococcal antigen (CRAG) titer in patients with cryptococcosis with or without human immunodeficiency virus (HIV).
 



 

Methods:

From January 1999 to December 2007, 45 patients with a diagnosis of cryptococcosis made by culture and/or histopathology were enrolled in this retrospective study. Ten patients had HIV and 35 were not infected.
 



 

Results:

Patients with HIV were more likely to have central nervous system (CNS) involvement than patients without HIV (100% vs 37.1%; p = 0.0005), higher serum CRAG titers (median, 1:1024 vs 1:64; p < 0.05), higher positive cerebrospinal fluid (CSF) CRAG (100% vs 37.1%; p = 0.0005), and higher CRAG titers in the CSF (median, 1:1024 vs 1:32; p < 0.001). Patients without HIV were more likely to have pulmonary involvement (62.9% vs 0%; p = 0.0005) and no underlying disease at diagnosis (42.9% vs 0%; p = 0.011). Serum CRAG titers among patients without HIV with CNS or pulmonary cryptococcosis declined during treatment and no relapse was noted when serum CRAG titers were ≤1:8 at the end of treatment.
 



 

Conclusion:

Serum CRAG titer can be used to monitor disease activity during treatment for CNS and pulmonary cryptococcosis in patients without HIV.



 

Key words:

Antigens; Cryptococcosis; Cryptococcus neoformans; HIV

 



 

J Microbiol Immunol Infect. 2009;42:220-226.