Features of the diagnosis of defeat of the nervous system of yeast-like fungi of the genus Candida spp., Cryptococcus spp.

Abstract

Objective. To carry out a comparative analysis of the informative value of different methods of diagnosing the nervous system damage due to Candida and Cryptococcus spp.Materials and methods. The article presents the results of a complex mycological examination of 170 patients with neuroinfection treated in the Department of Intensive Care and Detoxification of Gromashevsky Institute of Epidemiology and Infectious Diseases. The study was conducted during hospitalization, on the 14th, 21st day of treatment. The cryptococcal antigen in CMP was detected using latex agglutination reaction with qualitative and semi-quantitative CALAS®, Meridian Bioscience, Europe test system.Results. Cryptococcal meningoencephalitis (CrMe) was diagnosed in 15.88% (38.46% among HIV-infected), Candida meningoencephalitis (CME) in 3.53% of patients with neuroinfection. General clinical findings of the cerebrospinal fluid (CSF) are not informative enough, but do not fully reflect the inflammatory process in the nervous system, especially in HIV-infected and cancer patients. CSF microscopy and the culture method confirm the diagnosis of CrMe, CME only in 66.67% patients with HIV-negative status and in 33.33% HIV-infected patients. The article presents the results of CSF study by latex agglutination (RLA) for detecting cryptococcal antigen (CrAg).Conclusions. RLA for detecting CrAg in CSF should be considered as the basic method for early diagnosis of CrMe. In 71.43% HIV-patients, RLA CrAg in CSF was detected by negative microscopy. In CME patients PCR should be considered as the most informative and sensitive diagnostic method in difficult cases.