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To the Editor: South Africa is presently experiencing an epidemic of HIV-associated diseases, including cryptococcal meningitis. Cryptococcus is a fungal-type organism, and disseminated or cryptococcal meningitis is an AIDS-defining disease, occurring in up to 10% of patients with AIDS. In Durban, South Africa, cryptococcal meningitis was the initial AIDS-defining illness in 84% of HIV patients,1 while in Pretoria it was found to be the presenting cause for patients with HIV and meningitis in 50% of patients. 2 Its incidence at Pretoria academic hospitals has more than doubled over the past year (Levay, unpublished findings). The clinical presentation of patients with cryptococcal meningitis varies from headache (>95%) to coma. The diagnosis of cryptococcal meningitis presently rests on lumbar puncture demonstrating cryptococcal organisms by smear, antigen or culture. This is an invasive and costly procedure and is associated with patient discomfort. It would be ideal if a screening test could be used to exclude this diagnosis based on a simple blood examination, such as C-reactive protein (CRP). This test would mean less discomfort for the patient, in addition to decreased laboratory examination costs, especially as the patients may present with a mild symptom such as headache. To determine the usefulness of serum CRP levels in patients with cryptococcal meningitis on the day of presentation, a retrospective analysis was done on patients with cryptococcal meningitis. Following ethical clearance from the Ethical Committee of the University of Pretoria, patients were identified by searching the database of the Institute of Pathology at the

Do normal C-reactive protein levels exclude the diagnosis of cryptococcal meningitis?