Correlation between serum cryptococcal antigen titre and meningitis in immunocompetent patients

Gassiep, Ian;Chaw, Aye;Armstrong, Mark;Emeto, Theophilus I.;Heather, Christopher S.;Norton, Robert E.

Abstract

The aim of this paper was to determine the correlation between serum cryptococcal antigen and a diagnosis of cryptococcal meningitis in the immunocompetent cohort. A retrospective multicentre analysis of immunocompetent patients diagnosed and treated for cryptococcal meningitis between January 2000 and December 2017 was performed. Sixty-seven of the 143 cases of cryptococcosis occurred in immunocompetent patients. The serum cryptococcal antigen titre was significantly higher in the meningitis group [1 : 256 (IQR: 64–1024)] compared with that for non-meningitis patients [1 : 64 (IQR: 8–256)], P=0.012. The relative risk of meningitis with a serum cryptococcal antigen (CRAG) >1 : 64 was 1.8 (95 % CI: 1.15–2.82). This study demonstrates a clear correlation between serum cryptococcal antigen titre and meningitis. While the serum titre is not definitive for meningitis, in resource-limited settings or cases where lumbar puncture may be contraindicated, this evidence may aid diagnosis and subsequent therapeutic decisions.

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Journal of Medical Microbiology

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1473-5644

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Society for General Microbiology

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DOI

10.1099/jmm.0.000830