CRYPTOCOCCAL ANTIGEN-DETECTION FROM THE URINE OF AIDS PATIENTS

Cryptococcal disease occurs in less than or equal to 10% of AIDS patie nts. Detection of the capsular polysaccharide antigen of the yeast in spinal fluid or serum is used to establish the diagnosis. In addition, cryptococcal antigen (CAg) analysis is used to adjust treatment and e valuate recurrence of active disease. A specimen such as urine, obtain ed noninvasively, would be optimum for this evaluation. Urine, cerebro spinal fluid (CSF), and serum for CAg analysis, and culture of urine a nd CSF, were obtained for 103 sets of specimens from 92 patients. CSF and urine specimens for CAg were analyzed with and without pronase tre atment; serum was analyzed with pronase only. Twenty percent (21 of 10 3) of specimen sets showed CAg from eight patients. In all cases, pati ents with positive CSF and/or serum titers also had positive urine tit ers. Titers were always serum > CSF > urine, with ranges of 1:64-65000 ; 1:64-6250; and 1:2-512, respectively. Pronase treatment did not affe ct CSF titers, but 14 of 23 titers from urine treated with pronase wer e at least one dilution higher than those without treatment. No false- positive reactions were observed during the study. CSF cultures were p ositive from seven of eight, and urine cultures were positive from fiv e of eight patients with CAg. These results indicate that urine can be used as a specimen for detection of CAg in AIDS patients and that use of pronase may increase its sensitivity.