1887

Abstract

Summary

Cryptococcus coagglutination (COA) test reagent was prepared locally and showed no cross reactions with different species of bacteria or yeasts or with 75 control sera including 25 that gave positive results for RA factor. We used the COA test to detect cryptococcus antigen in the CSF and we could confirm the diagnosis of 11 out of 115 suspected cases of fungal meningitis; the titre varied from 4 to 128. A four-fold rise in titre confirmed the diagnostic value and a steady fall in titre in three patients on therapy indicated the prognostic value of the test. The earliest confirmation was in a renal transplant patient on the eighth day after onset of symptoms. The COA test was negative with the CSF of 118 patients with chronic meningitis. Cryptococcal colony forming units (cfu) in CSF varied from 100 to > 100 000/ml and correlated well with microscopy and with the COA antigen titre in CSF. Four out of the 11 patients who had cryptococcaemia, had 50 000-100 000 cfu/ml in the CSF. Cryptococcus antigen was detected by COA in the serum of all 11 patients, even in those with only 100 cfu/ml in CSF. In the three post-renal transplant patients, who were being monitored regularly, the diagnosis was made early and all three recovered on antifungal therapy with no relapse to date (1-2 years). All the others, including the two primary CNS infections, succumbed to the disease because they presented late for diagnosis and therapy. The cryptococcus COA test is a simple and specific test that can be used as a rapid test to confirm early diagnosis and permit prompt therapy, which should improve the prognosis in CNS and other forms of systemic cryptococcosis. Moreover, it is reproducible and cost-effective, particularly in countries where the latex and other expensive test reagents are not generally available.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/00222615-29-3-189
1989-07-01
2022-01-24
Loading full text...

Full text loading...

/deliver/fulltext/jmm/29/3/medmicro-29-3-189.html?itemId=/content/journal/jmm/10.1099/00222615-29-3-189&mimeType=html&fmt=ahah

References

  1. Ajello L., Georg L. K., Kaplan W., Kaufman L. 1966; The yeastlike fungi. In Laboratory manual for medical mycology, section E. Communicable Diseases, Center U. S. Department of Health, Education and Welfare Public Health Service, El;
    [Google Scholar]
  2. Bindschadler D. D., Bennett J. E. 1968; Serology of human cryptococcosis. Annals of Internal Medicine 69:45–52
    [Google Scholar]
  3. Butler W. T., Ailing D. W., Spickard A., Utz J. P. 1964; Diagnostic and prognostic value of clinical and laboratory findings in cryptococcal meningitis, a follow-up study of forty patients. New Zealand Journal of Medicine 270:59–62
    [Google Scholar]
  4. Christensen P., Kahlmeter G., Johnson S., Kronvall G. 1973; New method for the serological grouping of streptococci with specific antibodies absorbed in protein A-containing staphylococci. Infection and Immunity 7:881–885
    [Google Scholar]
  5. Dolan C. T. 1972; Specificity of the latex-Cryptococcal antigen test. American Journal of Clinical Pathology 58:358–364
    [Google Scholar]
  6. Fujita N. K., Reynard M., Sapico F. L., Guze L. B., Edwards J. E. 1981; Cryptococcal intracerebral mass lesions. Annals of Internal Medicine 94:382–388
    [Google Scholar]
  7. Ikeda R., Shihoda T., Fukazawa Y., Kaufman L. 1982; Antigenic characterisation of Cryptococcus neoformans serotypes and its application to serotyping of clinical isolates. Journal of Clinical Microbiology 16:22–29
    [Google Scholar]
  8. Kaufman L., Blumer S. 1973; Latex-cryptococcal antigen test. American Journal of Clinical Pathology 60:285–286
    [Google Scholar]
  9. Khan M. J., Myers R., Koshi G. 1959; Pulmonary cryptococcosis, a case report and experimental study. Diseases of the Chest 36:656–660
    [Google Scholar]
  10. Koshi G., Sudersanam D., Selvapandian A. J., Myers R. M. 1964; Cryptococcosis ‘masquerading’ as tuberculosis of the spine. Indian Journal of Pathology and Bacteriology 7:264–271
    [Google Scholar]
  11. Koshi G., Thangavelu C. P., Brahmadathan K. N. 1979; The reliability and rapidity of the coagglutination technique and its comparison with precipitin technics in the grouping of streptococci. American Journal of Clinical Pathology 71:709–712
    [Google Scholar]
  12. Koshi G., Viswanath A., Chandy M., Jairaj P. S. 1987; Development of a coagglutination (COA) technique to detect Candida antigenemia. I. COA versus Candida isolation. American Journal of Clinical Pathology 88:429–435
    [Google Scholar]
  13. Lauter C. B. 1977; Commercial test sensitivity to cryptococcal antigen (letter). Annals of Internal Medicine 86:240
    [Google Scholar]
  14. Maccani J. E. 1981; Rapid presumptive identification of Cryptococcus neoformans by staphylococcal coagglutination. Journal of Clinical Microbiology 13:828–832
    [Google Scholar]
  15. Myers R. M., Koshi G. 1982; Blood. In Diagnostic procedures in medical microbiology and immunology/serology Chapter 3, Part II IELC Concordia Press and Training Institute; Vaniyambadi:635–751 Tamil Nadu, p 19
    [Google Scholar]
  16. Perfect J. R., Durack D. T., Gallis H. A. 1983; Cryptococcemia. Medicine 62:98–109
    [Google Scholar]
  17. Sapico F. L. 1979; Disappearance of focal cryptococcal brain lesion on chemotherapy alone (letter). Lancet 1:560
    [Google Scholar]
  18. Scott E. N., Muchmore H. G., Felton F. G. 1980; Comparisons of enzyme immunoassay and latex agglutination methods for detection of Cryptococcus neoformans antigen. American Journal of Clinical Pathology 73:790–794
    [Google Scholar]
  19. Silva-Hunter M., Cooper B. H. 1980; Yeasts of medical importance. In Lennette E. H. (eds.) Manual of clinical microbiology 3rd edn American Society for Microbiology; Washington DC: pp 562–576
    [Google Scholar]
  20. Stein J. M., Burdon P. J. 1960; Cryptococcus neoformans infection of the central nervous system: A case treated by amphotericin B with post-mortem examination. Annals of Internal Medicine 52:445–453
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/00222615-29-3-189
Loading
/content/journal/jmm/10.1099/00222615-29-3-189
Loading

Data & Media loading...

Most cited this month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error