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[Quasi-normal cerebrospinal fluid in patients with acquired immunodeficiency syndrome and cryptococcal meningitis]
Abstract:
We report eight patients with cryptococcal meningitis and a cerebrospinal fluid characterized by few or no white blood cells and chemistries that may be near normal. In four of these patients, only testing for cryptococcal antigen allowed the initial diagnosis. Seven of the patients had a certain diagnosis of AIDS. Six have died. Autopsies performed in two cases indicated a poor meningeal inflammatory response. Contrary to the findings in most immunodeficient patients, in AIDS cryptococcal meningitis may present with few cellular or biochemical abnormalities in the cerebrospinal fluid. In AIDS patients presenting with headache and fever or change in mental status, examination of the cerebrospinal fluid should not be limited to routine studies.
Insights
Cryptococcal meningitis in AIDS patients can present with normal cerebrospinal fluid tests. Early diagnosis requires cryptococcal antigen testing, as routine studies may be misleading.
Area of Science:
- Infectious Diseases
- Neurology
- Immunology
Background:
- Cryptococcal meningitis is a serious opportunistic infection, particularly in individuals with advanced HIV/AIDS.
- Typical cerebrospinal fluid (CSF) findings include pleocytosis and elevated protein levels.
Observation:
- Eight patients with cryptococcal meningitis exhibited CSF with minimal white blood cells and near-normal chemistries.
- Four patients required cryptococcal antigen testing for initial diagnosis.
- Seven patients had a confirmed diagnosis of Acquired Immunodeficiency Syndrome (AIDS).
Findings:
- In contrast to other immunodeficient states, cryptococcal meningitis in AIDS patients may lack typical inflammatory markers in CSF.
- Autopsies revealed a poor meningeal inflammatory response in two cases.
- Six of the eight patients died, highlighting the severity of the condition in this population.
Implications:
- Standard CSF analysis may fail to detect cryptococcal meningitis in AIDS patients.
- Clinicians should consider cryptococcal antigen testing in AIDS patients with neurological symptoms like headache, fever, or altered mental status.
- Diagnostic approaches for cryptococcal meningitis in AIDS require tailored strategies beyond routine CSF examination.