SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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L. Taborsky1 , P. Adam1 , O. Sobek1 , J. Dvorakova1 , L. Dubska1

1Dpt. Clin. Biochemistry, Hospital Na Homolce, Prague 5

Overwiew:
Diagnosis of Cryptococci Meningitis is very rare. Our aim was to find appropriate staining procedure for detection of Cryptococci. Using basic stain performed routinely in our country, it is i.e. May-Grünwald-Giemsa, the Cryptococci imposed like small deformated lymphocytes. We tryied to use several staining procedures how to detect the presence of Cryptococci specifically in CSF cytological preparation.
Material and methods:
Evaluated group consist of 11 patients where Cryptococci were detected using different staining procedures. Two male patients were immunocompromised, in one patient Non-Hodgkin lymphoma was present, the second one was HIV positive. Generally, presence of lymphocyte or granulocyte pleocytosis was observed.
Using Alcian blue the specific detection is based on the presence of mucopolysaccharides in the Cryptococci capsules. The staining process can be combined with nuclear fast red to prove the presence of nuclei. PAS positivity was also a typical feature. Presence of fagocytosis of CM by mycophages was frequently documented.Usual cytological finding is pleocytosis with prevalence of neutrophiles. In lymphocyte series,the finding of activated elements and plasma cells isusual. Activation in monocytes series and presence of lipophagic elements is frequently observable.
Conclusiones:
For establishment of dg, the proof of presence of CM is inevitable, comprising several staining methods, because while using the basic stain, the cryptococci can impose like small lymphocytes. Presence of mucopolysacharide capsules of cryptococci enables their proof by using PAS reaction, Alcian Blue stain, or by Gramm stain.The other CSF finding comprise impairment of CSF-blood barrier with elevated total protein, and elevation of CSF inflammatory markers; e. g., TRF, Haptoglobin, Prealbumin. Hypoclycorrhachia is also a frequent finding.
As most convenient methods for the specific detection of macrophages, the use of Alcian blue and PAS reaction was proved.

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