Pathophysiology and clinical outcomes of subclinical cryptococcal meningitis (SubEFFECT):

Sub-EFFECT is a prospective observational cohort study investigating the pathophysiology and clinical outcomes of individuals with subclinical cryptococcal meningitis (cerebrospinal fluid (CSF) positive for Cryptococcus in the absence of meningitis signs and symptoms). Very little is currently known about this patient population. High mortality rates are still seen among asymptomatic cryptococcal antigen (CrAg)-positive patients identified through CrAg screening, despite preemptive fluconazole treatment which may be due to undiagnosed cryptococcal meningitis. Indeed, CM has been detected in around 1/3 CrAg positive individuals without overt symptoms.

Sub-EFFECT will recruit individuals excluded from the EFFECT trial on the basis of a positive CSF CrAg in order to answer a number of important fundamental questions around cryptococcal disease progression. More detail on the trial and the trial background can be found here.


Principal Investigators:

Dr Rae Wake,
Institute of Infection and Immunity, St. George’s University of London, UK

Dr Síle Molloy,
Institute of Infection and Immunity, St. George’s University of London, UK; Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses (CHARM), National Institute for Communicable Diseases (NICD), South Africa


St George’s, University of London (SGUL)


Springboard award, UK:

Academy of Medical Sciences (AMS) supported by Wellcome Trust, Government Department of Business, Energy and Industrial Strategy (BEIS), British Heart Foundation and Diabetes UK and Global Challenges Research Fund (GCRF) and the National Institute for Health Research.