The Disscussion Of CSF 14-3-3 Protein And Cytology In The Diagnosis And Prognosis Of Cryptococcal Meningitis

Objective: Cryptococcal meningitis (CM) a chronic central nervous system infection disease caused by Cryptococcus neoformans and its variants. It is the most common fungal infection of the central nervous system . The incidence of CM has increased in recent years. A number of factors have contributed to this increase; these include the increasing prevalence of AIDS, the use of corticosteroids in autoimmune diseases, the use of radio- and chemotherapy for cancer therapy, and the long-term use of immunosuppressants after organ transplantation. In the West, cryptococcal meningitis has been called the "awakening giant" . In China, CM ofen occur in patients with other forms of immunosupression individuals.In recent years,cases also occur in patients with HIV postive and in apparently immunocompetent individuals. We should improve the recognization on CM and investigate the early diagnosis method and effective treatment.A great quantitiy of investigations have indicateded that the prognosis of CM is largely dependent on the early diagnosis and early treatment. In the diagnosis of cryptococcosis, we have adopted a variety of methods .The first detection of cryptococcal meningitis has improved significantly. But at present, a series of pathological processes between bacterial pathogens and host defense is unclear. 14-3-3 protein as a regulator of many physiological processes in neurons ,its role is unclear. Our research was designed to detect 14-3-3 protein in cerebrospinal fluid and check the cerebrospinal fluid cytology of CM patients. Then we can find the significance of 14-3-3 protein in CM patients. It can help us understand the pathogenesis of cryptococcal meningitis to some extent.Methods: All patients are from department of Neurology of the second hospital of Hebei Medical University.These 52 patients were divided into two groups. One group include 34 patients with CM. The other group include 18 patients with other diseases of central nervous system. All patients'CSF were collected in 24 to 48 hours. They were undertaken the routine test and CSF cytologic(CSFC)examinations(including CSFC May-Grunwald-Giemsa(MGG) staining, CSFC aricine blue staining, India ink staining). Then we apply the ABC-ELISA method to measure the level of 14-3-3 protein of 16 cases of CM patiens and 18 cases of control group patients. We dynamically observed 16 cases of CM patients and observe the effects of its treatment, and compared the content of 14-3-3 protein in CSF before and after treatment of these 16 cases of CM patiens.Results:1 The morbidity rate and case fatality rate of CM:The hospitalization number of CM was in the January 2004--December 2009 6-year period was 34,the case fatality of CM was 26.47%. And six patients suffering from AIDS.The hospitalization number of CM was in the Janury 2004-- December 2006 3-year period was 12, the case fatality of CM was 41.67%. The hospitalization number of CM was in the Janury 2007-- December 2009 3-year period was 22, the case fatality of CM was 18.18%.2 The time interval from the onset of symptoms to diagnosis of CM patiens: time interval of 34 cases CM patients from 7 days to 3 months. The average time is 29.5±22.99 Tian.3 The misdiagnosis of CM:There are 23 cases were misdiagnosed .They were misdiagnosed as viral meningitis or tubercular meningitis.4 Underlying disease: There are 20 cases of patients with underlying diseases (including blood disorders, immune system diseases, AIDS and diabetes, etc.) or long-term history of poultry exposure (58.82%).5 Aetiology: 34 patients detected cerebrospinal fluid cytology (including ordinary ink stain, MGG stain, A Lixin blue staining and centrifugation ink stain), all are positive.6 The detection of 14-3-3 protein and CSFC: Compare the 14-3-3 protein levels in cerebrospinal fluid in case group (3.57158±4.2635 ng/ml) and control group(0.318±0.3988ng/ml),there was a statistical significance. Compare the 14-3-3 protein levels in cerebrospinal fluid before treatment(4.6199±5.3423ng/ml)and after treatment (1.1389±1.1737ng/ml) , it didn't have a statistical significance. Compare the 14-3-3 protein levels in cerebrospinal fluid in underlying disease (1.7277±2.2614ng/ml)and in no underlying disease (4.6778±4.8814ng/ml), it didn't have a statistical significance.Conclusions:1 In recent years ,the incidence of CM has risen markedly and cases ofen occur in patients with HIV postive in our country, so we should improve our vigilance on CM.2 By measuring the Soluble interleukin-2 receptor in cerebrospinal fluid prompts the body infected by Mycobacterium tuberculosis mainly start the T cell-mediated immunity, and the body in a state of disordered immune regulation. Through dynamic observing the changes has the significance of disease monitoring and assessment of prognosis in patients with tuberculous meningitis.3 CM has high misdiagnosis rate and case fatality rate,so the important turning point is early diagnosis and effective treatment.4 The patients who's immune function is low are susceptibility to be troubled with cryptococcal meningitis, so patients who have underlying diseases if their clinical manifestations are meningitis should be highly vigilant against the disease.5 The use of CSFC MGG staining, CSFC aricine blue staining and India ink staining should be united in order to improve the positive detection rate of the Cryptococcus.6 14-3-3 proteins in cerebrospinal fluid can help us to understand the damage of nervous system in patients with cryptococcal meningitis...