[A clinical study of cryptococcal meningitis--sequential changes of cryptococcal antigen titers]

Area of Science:

• Infectious Diseases
• Clinical Mycology
• Immunology

Background:

• Cryptococcal meningitis is a serious opportunistic infection, particularly in immunocompromised individuals.
• Accurate monitoring of treatment response is crucial for managing cryptococcal meningitis.
• Cryptococcal antigen titers in serum and CSF are key diagnostic and prognostic markers.

Observation:

• Three patients with cryptococcal meningitis and underlying systemic diseases (liver cirrhosis, lymphoma, thymoma with lupus) were studied.
• Clinical manifestations, sequential cryptococcal antigen titers (serum and CSF), and antifungal drug susceptibility were analyzed.
• Higher antigen titers were observed in serum compared to CSF, with variations between latex agglutination methods.

Findings:

• All patients showed a decrease in serum and CSF cryptococcal antigen titers following treatment with various antifungal regimens (AMPH-B, 5-FC, FLCZ).
• CSF antigen titers decreased to <8 within 1.7–7.3 months, while serum titers remained elevated in some cases during this period.
• Minimum inhibitory concentrations (MICs) for tested antifungals (AMPH-B, 5-FC, FLCZ, miconazole, itraconazole) were determined.

Implications:

• Sequential measurement of cryptococcal antigen titers in serum and CSF is a valuable tool for evaluating treatment response in cryptococcal meningitis.
• Understanding the dynamics of antigen titer reduction can inform clinical management and prognosis.
• This study highlights the importance of monitoring antigen levels for effective therapeutic assessment in complex patient cases.