CRYPTOCOCCAL MENINGITIS IN NON-HIV PATIENTS
Perfect JR, Casadevall A. Cryptococcosis. Infect Dis Clin North Am. 2002 Dec;16(4):837-74
Take home points:
1. The serum CrAg is often negative in non-HIV patients
2. Cryptococcal meningitis can occur in any immunocompromised patient, in patients treated with steroids,
and can occur sporadically, especially in older patients (incidence similar to meningococcal meningitis).
3. CSF can be more abnormal in non-HIV patients then in patients with HIV, where CSF is typically bland.
4. Treatment of cryptococcal meningitis in non-HIV patients is based on studies in HIV patients; however,
these patients may not need life-long therapy with oral azoles. It is unclear whether treating elevated
opening pressures is important in these patients.
Causes of a false negative serum cryptococcal antigen test: tests for antigen against crypto surface polysaccharide
• The serum CrAg is often negative in non-HIV patients
• Low titers of cryptococcus
• Early infection
• Presence of immune complexes
• Poorly encapsulated strains with low production of polysaccharide
• Prozone phenomenon of high titers
Treatment of cryptococcal meningitis in non-HIV patients: