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  Laboratory Diagnosis

Laboratory Diagnosis:

Direct Microscopy and staining: CSF can be employed for direct examination. In AIDS patients the yeast cells are many in number. The yeast cells of C. neoformans are approximately, 4 to 10 µm in diameter and are bounded by a mucopolysaccharide capsule. CSF is mixed with a drop of ink or nigrosine and noticed under microscope. The capsule can be viewed as a clear halo around the yeast cells.

Sputum, pus or brain tissues must be digested in potassium hydroxide before examination. For the examination of tissue sections, special fungal stains such as PAS can be employed. Alcian blue and musicarmine stain the capsular material and is helpful to distinguish C. neoformans from the other capsulated organisms.

Culture:

The yeast cell is cultured on Sabouraud’s agar at 25 to 30oC and 37oC. Colonies emerge in 2 to 3 days however culture must be kept for 3 weeks. In culture, C. neoformans emerge as creamy white to yellow brown colonies and few are mucoid with well generated capsules and some might be dry that lack prominent capsules. Buds emerge at any point on the cell surface however mycelium or pseudomycelium are not generated. Direct explanation of capsulated yeast cells in CSF is the preliminary recognition. It is confirmed by its capability to generate the enzyme urease.

Antigen detection:

Latex agglutination test is employed for the detection of capsular polysaccharide antigen in CSF or blood. This test is extremely specific and sensitive for the detection of cryptococcal meningitis and provides better outcomes than microscopy and culture. In AIDS patients over 90 percent shows positive by this test. ELISA can also be employed for the detection of antigen.

Antibody detection:

A complete cell agglutination test for serum antibody is in less than 50 percent of the proven situations of Cryptococcal meningitis. This is since the antibodies are neutralized by antigen discharged during infection. Antibodies might reappear after treatment in the normal persons however not in the AIDS patients.

Treatment:

Immunocompetent persons are treated with oral fluconazole or itraconazole. For immunocompromised persons amphotericin B in combination with flucytosine is provided intravenously. AIDS patients generally relapse after the primary course of therapy and might react badly to the drugs.

Control:

Individuals at risk of building up cryptococcosis must avoid contact with birds.

 

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