Title: Clinical Profile and Disease Outcome of Cryotococcal Meningitis in Patients with HIV/AIDS Infection: A Prospective Study at Tertiary Care Centre in North India
Authors: Dr Sanjay Fotedar, Dr Anubha Garg, Dr Angshuman Mukherjee, Dr Vinay Rampal, Dr Zahid H. Gilani
DOI: https://dx.doi.org/10.18535/jmscr/v7i10.86
Abstract
Background: Cryptococcus neoformans is the common opportunistic infections (OI), in people living with HIV/AIDS (PLHA) and cryptococcal meningitis (CM) the main clinical manifestation adds to morbidity and mortality, 10-30%. Management includes concurrent treatment of HIV infection and specific management of cryptococcal meningitis, potent fungicidal drugs include amphotericin and flucytosine, though flucytosine is not available in limited resource settings, fluconazole is used as alternative.
Objectives: To study the clinical profile and disease outcome of cryptococcal meningitis in patients living with HIV/AIDS infection (PLHA).
Material and Methods: An prospective study from a tertiary care centre at Northern India. Patients with HIV/AIDS infection (PLHA) presenting with signs and symptoms of CNS infection, diagnosed as cases of cryptococcal meningitis (CM) were evaluated and respective data collected.
Results: Twenty three with HIV/AIDS infection were diagnosed as cases of CM and evaluated. 16(69%) presents with CM as AIDS defining illness. Common clinical features included Headache (90%), fever (80%), followed by vomiting and altered sensorium. CD4 count <100 was significantly associated with CM. On CSF analysis cryptococcal Ag was +ve in 23 and India ink tested +ve in 16 patients. On neuro imaging meningeal enhancement was the commonest finding followed by localized ring shaped lesions, hydrocephalus and infarct.
Conclusion: The disease burden is more in developing and underdeveloped nations with high incidence of human immunodeficiency virus infection. Individuals infected with HIV infection may develop CM in course of HIV disease or may present with cryptococcal meningitis as AIDS defining illness. High degree of clinical suspicion and timely induction of treatment is associated with better outcomes.
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