Cryptococcal Meningitis: Sensitivity and Specificity

Introduction: Cryptococcal meningitis is caused by Cryptococcus neoformans and typically causes extremely high intracerebral pressures. Note that the serum antigen test is sensitive for AIDS patients only.

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The sensitivity and specificity of findings for Cryptococcal Meningitis are listed below. See the left navigation bar to change the display.

Imaging

Non-contrast Head CT

Sensitivity = 17%

abnormal findings include cryptococcomas and hydrocephalus. these were more common in non-AIDS and especially immunocompetent hosts.

Study: Clin Infect Dis. (2000) 31 (2): 499-508. http://cid.oxfordjournals.org/content/31/2/499.long

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Finding	Sensitivity	Specificity	Comments, Study
Cryptococcal Antigen in CSF	93%	93%	at least 93% sensitivity and specificity (depending on the kit), versus culture as gold standard similar sensitivity numbers from different series, across host types (see second reference) Study: J Clin Microbiol. 1994;32(7):1680-4. PMID 7929757 J Clin Microbiol. 2005 Nov;43(11):5828-9. PMID: 16272534
Cryptococcal Antigen in Serum Duplicate	99%	83.3%	in AIDS patients! Specificity is from the first reference, which gives a sensitivity of only 91%. Study: J Med Assoc Thai. 1999;82(1):65-71. PMID 10087741 J Clin Microbiol. 2005 Nov;43(11):5828-9. PMID: 16272534
Cryptococcal Antigen in Serum Duplicate	Sensitivity = 87%		non-HIV immunocompromised. No data for immunocompetent hosts. Study: J Clin Microbiol. 2005 Nov;43(11):5828-9. PMID: 16272534
India Ink stain of CSF	Sensitivity = 75%		in AIDS patients. sensitivity is 50% in non-AIDS patients Study: UpToDate, references PMID 3299095 and PMID 4811791