Antigen Titers in Cryptococcal Meningitis: What Determines How Fast They Fall?

• Published in: The Journal of infectious diseases Vol. 230; no. 5; pp. 1291 - 1296
• Main Authors: Bennett, John E, Williamson, Peter R
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 15.11.2024
• Subjects: Adult; Antigens, Fungal - blood; Antigens, Fungal - cerebrospinal fluid; Cerebrospinal fluid; Cryptococcus gattii; Cryptococcus neoformans - immunology; Disease control; Female; Humans; Major; Male; Meningitis; Meningitis, Cryptococcal - cerebrospinal fluid; Middle Aged; Population decline; Time Factors; Ventriculoperitoneal shunt; antigen; polysaccharide; cryptococcosis; ventriculoperitoneal shunt; cerebrospinal fluid
• ISSN: 0022-1899; 1537-6613; 1537-6613
• DOI: 10.1093/infdis/jiae354

Abstract Follow-up of previously healthy patients surviving cryptococcal meningitis found that cryptococcal antigen could be detected for >1 year in serum from 38 of 44 (86%) patients and in cerebrospinal fluid (CSF) from 20 of 31 patients (67%), far beyond the time of culture conversion. The speed of titer decline, measured as the number of days for a 2-fold drop in titer to occur, was slower in serum than in CSF. The speed of decline of antigen titers was much slower in serum and CSF for patients infected with Cryptococcus gattii than Cryptococcus neoformans. The speed of decline in CSF and serum titers was also much slower in patients who had received a ventriculoperitoneal shunt for increased intracranial pressure. The variable and extraordinarily slow rate of clearance in our patients did not appear to reflect differences in disease control but rather differences in species and shunting for increased intracranial pressure. Cryptococcal polysaccharide antigen persisted in the serum and cerebrospinal fluid of patients with cryptococcal meningitis far beyond clinical cure, falling more slowly in serum than cerebrospinal fluid and in Cryptococcus gattii than Cryptococcus neoformans infection and more slowly in patients with a ventriculoperitoneal shunt.