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Disease Markers
Volume 2014, Article ID 162576, 10 pages
http://dx.doi.org/10.1155/2014/162576
Research Article

Importance of Follow-Up Cerebrospinal Fluid Analysis in Cryptococcal Meningoencephalitis

1Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße-1, 30625 Hanover, Germany
2Department of Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany
3Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, 30625 Hannover, Germany
4Department of Neurology, University of Lübeck, 23538 Lübeck, Germany
5Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, 30625 Hannover, Germany

Received 2 July 2014; Accepted 15 September 2014; Published 13 October 2014

Academic Editor: Giuseppe Murdaca

Copyright © 2014 Thomas Skripuletz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cryptococcal meningoencephalitis represents a serious infection of the central nervous system, where reliable prognostic factors during the disease course are needed. Twenty-one patients diagnosed with cryptococcal meningoencephalitis in a German university hospital from 1999 to 2013 were analysed retrospectively. CSF parameters were analysed prior to therapy and during antifungal treatment and were compared between patients who survived or deceased. Fifteen patients clinically improved after antifungal therapy, while six patients died. No differences were observed between the outcome groups for the CSF parameters cell count, lactate, total protein, and CSF-serum albumin quotients (QAlb). Follow-up examinations of serum cryptococcal antigen titer and CSF cell count have shown that these parameters cannot be used to monitor the efficacy of antifungal therapy as well. In contrast, the course of QAlb during therapy was indicative for the outcome as a possible prognostic marker. In patients with clinical improvement QAlb values were falling under therapy, while rising QAlb values were found in patients with fatal outcome indicating a continuing dysfunction of the blood-CSF barrier. In conclusion, our results indicate that, among the various CSF parameters, the course of QAlb presents a promising marker that might be used to monitor the efficacy of antifungal therapy.