Symptomatic Cryptococcal Antigenemia Presenting as Early Cryptococcal Meningitis With Negative Cerebral Spinal Fluid Analysis

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dc.contributor.authorSsebambulidde, Kenneth
dc.contributor.authorKwizera, Richard
dc.contributor.authorKandole, Tadeo Kiiza
dc.contributor.authorTugume, Lillian
dc.contributor.authorKiggundu, Reuben
dc.contributor.authorMpoza, Edward
dc.contributor.authorNuwagira, Edwin
dc.contributor.authorWilliams, Darlisha A.
dc.contributor.authorLofgren, Sarah M.
dc.contributor.authorAbassi, Mahsa
dc.contributor.authorMusubire, Abdu K.
dc.contributor.authorCresswell, Fiona V.
dc.contributor.authorMuzoora, Conrad
dc.contributor.authorBoulware, David R.
dc.contributor.authorMeya, David B.
dc.contributor.authorfor the Adjunctive Sertraline for Treatment of HIV-associated Cryptococcal Meningitis Team
dc.date.accessioned2022-08-18T18:43:52Z
dc.date.available2022-08-18T18:43:52Z
dc.date.issued2019
dc.description.abstractIndividuals with cryptococcal antigenemia are at high risk of developing cryptococcal meningitis if untreated. The progression and timing from asymptomatic infection to cryptococcal meningitis is unclear. We describe a subpopulation of individuals with neurologic symptomatic cryptococcal antigenemia but negative cerebral spinal fluid (CSF) studies.We evaluated 1201 human immunodeficiency virus–seropositive individuals hospitalized with suspected meningitis in Kampala and Mbarara, Uganda. Baseline characteristics and clinical outcomes of participants with neurologic–symptomatic cryptococcal antigenemia and negative CSF cryptococcal antigen (CrAg) were compared to participants with confirmed CSF CrAg+ cryptococcal meningitis. Additional CSF testing included microscopy, fungal culture, bacterial culture, tuberculosis culture, multiplex FilmArray polymerase chain reaction (PCR; Biofire), and Xpert MTB/Rif.We found 56% (671/1201) of participants had confirmed CSF CrAg+ cryptococcal meningitis and 4% (54/1201) had neurologic symptomatic cryptococcal antigenemia with negative CSF CrAg. Of those with negative CSF CrAg, 9% (5/54) had Cryptococcus isolated on CSF culture (n = 3) or PCR (n = 2) and 11% (6/54) had confirmed tuberculous meningitis. CSF CrAg-negative patients had lower proportions with CSF pleocytosis (16% vs 26% with ≥5 white cells/μL) and CSF opening pressure >200 mmH2O (16% vs 71%) compared with CSF CrAg-positive patients. No cases of bacterial or viral meningitis were detected by CSF PCR or culture. In-hospital mortality was similar between symptomatic cryptococcal antigenemia (32%) and cryptococcal meningitis (31%; P = .91).Cryptococcal antigenemia with meningitis symptoms was the third most common meningitis etiology. We postulate this is early cryptococcal meningoencephalitis. Fluconazole monotherapy was suboptimal despite Cryptococcus-negative CSF. Further studies are warranted to understand the clinical course and optimal management of this distinct entity.en_US
dc.identifier.citationSsebambulidde, K., Bangdiwala, A. S., Kwizera, R., Kandole, T. K., Tugume, L., Kiggundu, R., ... & Meya, D. B. (2019). Symptomatic cryptococcal antigenemia presenting as early cryptococcal meningitis with negative cerebral spinal fluid analysis. Clinical infectious diseases, 68(12), 2094-2098.https://doi.org/10.1093/cid/ciy817en_US
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/4296
dc.language.isoenen_US
dc.publisherClinical infectious diseasesen_US
dc.subjectcryptococcal meningitis, HIV, diagnosis, fungal antigen, aseptic meningitisen_US
dc.titleSymptomatic Cryptococcal Antigenemia Presenting as Early Cryptococcal Meningitis With Negative Cerebral Spinal Fluid Analysisen_US
dc.typeArticleen_US
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