Changing paradigm of Cryptococcal meningitis: An eight-year experience from a tertiary hospital in South India.
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Date
2015-01
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Abstract
Background: Cryptococcal meningitis (CM) is a common opportunistic fungal infection causing sub-acute meningitis
with the potential for complications and signifi cant mortality. We conducted this study to describe the difference in
presentation and outcome between HIV-infected and HIV-uninfected patients. Materials and Methods: Patients
admitted to a tertiary care centre between 2005 and 2013 with confi rmed CM were included in the analysis. Details of
the clinical presentation, laboratory fi ndings, treatment details, risk factors for infection and outcome were documented
and analysed. Results: During the study period, 102 (87.2%) cases of CM occurred among HIV infected individuals,
whereas 15 (12.8%) occurred among HIV-uninfected patients. HIV-infected patients with CM were younger compared
with HIV-uninfected patients (38.2 ± 8.5 years vs. 45 ± 11.5 years; P = 0.07). The median duration of symptoms
prior to presentation was shorter in the HIV-infected group (20 ± 32 vs. 30 ± 42; P = 0.03). There was no difference
between the cerebrospinal fl uid (CSF) lymphocyte counts, CSF protein counts, and CSF sugar levels in both the
groups. The diagnostic yield of Cryptococcus was similar with CSF India ink smear (89% vs. 87%), CSF fungal
culture (95% vs. 87%), and blood culture (100% vs. 75%) in both the groups. Case fatality rate in the HIV-infected
group was 30.6%, whereas there were no deaths in the HIV-uninfected group. Conclusion: HIV-infected patients with
CM have a worse outcome compared to HIV-uninfected patients. The overall trend over 3 decades shows increasingly
successful rates of treatment and hence early diagnosis and treatment are of paramount importance.
Description
Keywords
Cryptococcal meningitis, HIV, clinical profi le, HIV uninfected
Citation
Abhilash K P P, Mitra S, Arul J J J, Raj P M, Balaji V, Kannangai R, Thomas S A, Abraham O C. Changing paradigm of Cryptococcal meningitis: An eight-year experience from a tertiary hospital in South India. Indian Journal of Medical Microbiology. 2015 Jan-Mar ; 33 (1): 25-29.