Profile of Central Nervous System Disease in HIV/AIDS Patients With Special Reference to Cryptococcal Infections

Abstract

Central nervous system involvement is common in acquired immunodeficiency syndrome (AIDS), with Cryptococcus neoformans being an important cause among etiologies causing fungal meningitis. Seventeen human immunodeficiency virus (HIV)-positive adults with symptoms of chronic meningitis were investigated for fungal meningitis because of C. neoformans and a correlation was attempted with the CD4 counts of these patients. Cerebrospinal fluid and blood samples were collected for direct microscopy, culture, and serology. CD4 counts were determined by flow cytometry. Cryptococcal meningitis was seen in 5 (29.4%) patients, tubercular meningitis in 9 (52.9%) patients, HIV encephalopathy in 2 (11.7%), and cerebral toxoplasmosis in 1 patient. In patients with Cryptococcal meningitis both methods, ie, an India ink preparation and Gram staining gave similar results. Culture was positive in 3 patients (60%) whereas Cryptococcal antigen in cerebrospinal fluid was positive in 4 (80%) patients. The mean CD4 count was 120 +/- 55.13 cells/microL. The study provides information about the increasing incidence of Cryptococcal meningitis after the AIDS pandemic. It indicates progression of HIV infection toward AIDS and is useful as a reference to starting antiretroviral therapy in settings where facilities for determination of CD4 counts are not available. It also confirms that the course of Cryptococcal meningitis in Indian patients is similar to most studies.