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False-Negative Antigen Test Results and Cultures in Nonimmunosuppressed Patients

Lisa Berlin, MD; Jonathan H. Pincus, MD

Arch Neurol. 1989;46(12):1312-1316.

Abstract
• All cases of cryptococcal meningitis at Yale-New Haven (Conn) Hospital seen during a 41/2-year period were reviewed to calculate the rate of false-negative antigen test results and cultures preceding diagnosis. Of 13 patients, 9 were immunosuppressed and were diagnosed following the initial lumbar puncture, with both antigen test results and cultures positive in all cases. Among 4 nonimmunosuppressed patients, the rate of false-negative antigen test results was 77%, and of cultures, 89%. The diagnosis was consequently delayed in 3, 2 of whom died despite treatment. Cryptococcal meningitis may be underdiagnosed and undertreated to a significant degree in nonimmunosuppressed patients.

Author Affiliations
From the Department of Neurology, Yale University School of Medicine, New Haven, Conn. Dr Pincus is now with the Department of Neurology, Georgetown University School of Medicine, Washington, DC.

Footnotes
Accepted for publication March 8, 1989.

Presented in part at the annual meeting of the American Academy of Neurology, New York, NY, April 8, 1987.

Reprint requests to Department of Neurology, Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007 (Dr Pincus).

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