Cryptococcal meningitis. False-negative antigen test results and cultures in nonimmunosuppressed patients.
All cases of cryptococcal meningitis at Yale-New Haven (Conn) Hospital seen during a 4 1/2-year period were reviewed to calculate the rate of false-negative antigen test results and cultures preceding diagnosis. Of 13 patients, 9 were immunosuppressed and were diagnosed following the initial lumbar puncture, with both antigen test results and cultures positive in all cases. Among 4 nonimmunosuppressed patients, the rate of false-negative antigen test results was 77%, and of cultures, 89%. The diagnosis was consequently delayed in 3, 2 of whom died despite treatment. Cryptococcal meningitis may be underdiagnosed and undertreated to a significant degree in nonimmunosuppressed patients.
Berlin
L
L
Department of Neurology, Yale University School of Medicine, New Haven, Conn.
Pincus
J H
JH
D000163:Acquired Immunodeficiency Syndrome / Q000134:cerebrospinal fluid / Q000150:complications; D000328:Adult; D000368:Aged; D000946:Antigens, Fungal / Q000134:cerebrospinal fluid*; D003453:Cryptococcosis / Q000134:cerebrospinal fluid* / Q000150:complications / Q000382:microbiology; D003455:Cryptococcus neoformans / Q000276:immunology / Q000302:isolation & purification; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D008581:Meningitis / Q000134:cerebrospinal fluid* / Q000209:etiology / Q000382:microbiology; D008875:Middle Aged; D012189:Retrospective Studies
D000946:Antigens, Fungal