Prevalence of cryptococcal meningitis in patients of acquired immunodeficiency syndrome: A single center experience from Regional Institute of Medical Sciences

Abstract

Objectives : To study the profile of cryptococcal meningitis in acquired immunodeficiency syndrome (AIDS) patients. Materials and Methods: AIDS cases admitted in the medicine ward of Regional Institute of Medical Sciences, Imphal from July 2003 to June 2011, with signs and symptoms of meningitis were included in the study. Routine cerebrospinal fluid (CSF) analysis, India ink preparation, cryptococcal antigen latex agglutination (CALA), adenosine deaminase, Vitek-2 technology for species identification, culture, and sensitivity for CSF, serum CALA, skin scraping, fine needle aspiration cytology from lymph nodes, sputum for Acid Fast Bacillus, Cryptococcus by Giemsa stain, computed tomography scan/magnetic resonance imaging brain, CD 4 T-cell count, HbsAg, Hepatitis C Virus-Ab and Venereal Disease Research Laboratory test were done for all patients. Results : Out of 391 AIDS cases, 89 had cryptococcal meningitis. Age ranged from 21 years to 61 years (Male:Female = 3.4:1). CSF findings were suggestive of chronic meningitis in 71 (78.86%) cases. Causative species of Cryptococcus strains were Cryptococcus neoformans in 86 cases and Cryptococcus albidus in 3 cases. India ink was positive in CSF examination in 74 (83.1%) cases while CSF and serum CALA were positive in 84.3% and 100% cases respectively.Mean CD4T-cell count was 44.64 ± 25.3. Commonest co-opportunistic infection was tuberculosis (n = 8). Hepatitis B virus and HCV co-infection was found in 2 and 5 cases respectively. Six cases out of 19 Anti-Retroviral treatment naοve patients developed cryptococcal meningitis as a result of Immune reconstitution inflammatory syndrome. Conclusion: Cryptococcosis is still prevalent in AIDS and new variants of cryptococcus other than C. neoformans have been detected.