Prevalence of cryptococcal meningitis among people living with human immunodeficiency virus/acquired immunodeficiency syndrome in a Tertiary Care Hospital, Southern Odisha, India.

OBJECTIVE

Cryptococcal meningitis (CM) caused by encapsulated opportunistic yeast Cryptococcus neoformans is an important contributor to morbidity and mortality in people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLHAs). Early diagnosis of such patients is the key to their therapeutic success. A retrospective study was conducted to evaluate the clinical features, laboratory findings, and prevalence of CM among hospitalized PLHAs in a tertiary care setting.

MATERIALS AND METHODS

A total of 112 clinically diagnosed CM patients were subjected to cerebrospinal fluid analysis and tests for human immunodeficiency virus antibodies by the standard laboratory operating procedures.

RESULTS

Out of 112, 16 showed a definite diagnosis of C. neoformans with the prevalence of 14.3%. Males in the age group of 21-40 years were most commonly affected than females. The clinical manifestations observed were fever and headache (100%), followed by altered sensorium (93.7%), neck stiffness (75%), and vomiting (62.5%). Overall, Cluster of differentiation 4 (CD4) T-lymphocytes count was <100 cells/μl except 1 case in which the CD4 T-lymphocytes count was 137 cells/μl. No concomitant cryptococcal and tubercular meningitis case was detected. All 16 patients responded initially to induction therapy of IV amphotericin B 1 mg/kg and fluconazole 800 mg daily for 2 weeks. Subsequently, 4 (25%) patients were lost for follow-up and 2 (12.5%) patients expired during their hospital stay.

CONCLUSION

As the clinical and radiological pictures of CM are often non-pointing, routine mycological evaluation is necessary for early definite diagnosis and subsequent initiation of appropriate therapy as the majority of patients respond well to treatment if started early.