Background:
Cryptococcal meningitis is a dreaded complication in HIV infected patients. It was associated with high mortality and morbidity before the advent of Highly Active Anti-Retroviral Therapy. A study was planned in
our institute to evaluate the clinical profile, laboratory findings, and prognostic factors for survival in these patients.
Settings and Design: A prospective hospital-based observational study, conducted in the Department of Medicine at a
tertiary care centre in western Rajasthan.
Method and Material:
HIV infected patients presenting with clinical features of meningitis, and positive CSF culture for
Cryptococcus were included in our study. All cases underwent detailed clinical history, physical examinations and relevant laboratory investigations including CD4 count and CSF examination.
Results:
48 HIV infected cryptococcal meningitis patients were analysed, and the most common presenting clinical features were headache (85.42%), and fever (72.92%), followed by neck stiffness (62.50%). CSF examination was also done
for Cryptococcal Antigen test which was reactive in all cases (100%), and India ink staining was positive in 43 cases
(89.58%). Significant fatal outcome was associated with patients presenting with altered sensorium, loss of consciousness, cranial nerve palsy and CD4 cell count of less than 100. Similarly, on laboratory and imaging diagnosis, cryptococcal antigen test (>3+reactive), fundus examination (papilloedema) and abnormal CT/MRI brain imaging were associated
with poor survival.
Conclusion:
Cryptococcal meningitis is a potentially lethal infection in immunocompromised individuals and should be
diagnosed early with high clinical suspicion as around 10% of the cases may not be detected on India ink staining and a
large proportion (75%) of cases may have normal imaging at initial evaluation. Early diagnosis, watchful eye on prognostic factors and treatment is vital to improve outcome in these patients.
Histopathology, serology and cultures in the diagnosis of cryptococcosis
