CELL-MEDIATED-IMMUNITY IN HIV SERONEGATIVE PATIENTS RECOVERED FROM CRYPTOCOCCUS-NEOFORMANS VAR GATTII MENINGITIS

Cell-mediated immunity was assessed in 37 HIV seronegative healthy pat ients cured of Cryptococcus neoformans var. gattii meningitis and comp ared with matched controls using a multitest device which simultaneous ly injects seven standardized common antigens intradermally. Responses in patients and controls were similar; however, male patients had sig nificantly higher compound (average) scores than controls (P = 0.041). Male scores were higher than female scores in both patient (P = 0.002 ) and control(P = 0.017) groups. In eight patients with acute cryptoco ccal meningitis, seven were anergic to challenge with 5 IU of tubercul in on admission. Two of these patients had positive reactions after tr eatment. Three of four patients tested prior to treatment with the mul titest device were anergic to all seven antigens but all three survivo rs showed improved responsiveness following cure. These data suggest t hat patients are immunosuppressed on presentation (due to overwhelming var. gattii infection) but that following cure, cell-mediated immunit y improves to its premorbid state. A transient state of immunosuppress ion prior to the development of the disease cannot be excluded.