How effective are cerebrospinal fluid (CSF) culture and antigen testing in the diagnosis of cryptococcal meningitis?

Updated: Jul 16, 2019
  • Author: Rodrigo Hasbun, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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C neoformans may be cultured from the CSF in cryptococcal meningitis. Other methods of identification include India ink preparation and the detection of CSF cryptococcal antigen. India ink has a sensitivity of only 50%, but it is highly diagnostic if positive.

Because of the low sensitivity of the India ink preparation, many centers have adapted the use of CSF cryptococcal antigen determination, a test with a sensitivity exceeding 90%. However, the CSF cryptococcal antigen determination is not universally available.

In instances when the India ink results are negative but the degree of clinical suspicion for cryptococcal meningitis is high, the CSF specimen may be sent to reference laboratories that can perform CSF cryptococcal antigen determination to confirm the diagnosis. In addition, the titer of the antigen could serve to monitor the response to treatment. Blood cultures and serum cryptococcal antigen should be obtained to determine whether cryptococcal fungemia is present.

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