Muktikesh Dash1, Sanghamitra Padhi1, Rani Sahu1, Jyotirmayee Turuk1, Swetalona Pattanaik1, Pooja Misra2
1 Department of Microbiology, Maharaja Krishna Chandra Gajapati Medical College and Hospital, Berhampur University, Berhampur, Odisha, India
2 Department of Radiodiagnosis, Maharaja Krishna Chandra Gajapati Medical College and Hospital, Berhampur University, Berhampur, Odisha, India
Objective: Cryptococcal meningitis (CM) caused by encapsulated opportunistic yeast Cryptococcus neoformans is an important contributor to morbidity and mortality in people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLHAs). Early diagnosis of such patients is the key to their therapeutic success. A retrospective study was conducted to evaluate the clinical features, laboratory findings, and prevalence of CM among hospitalized PLHAs in a tertiary care setting. Materials and Methods: A total of 112 clinically diagnosed CM patients were subjected to cerebrospinal fluid analysis and tests for human immunodeficiency virus antibodies by the standard laboratory operating procedures. Results: Out of 112, 16 showed a definite diagnosis of C. neoformans with the prevalence of 14.3%. Males in the age group of 21-40 years were most commonly affected than females. The clinical manifestations observed were fever and headache (100%), followed by altered sensorium (93.7%), neck stiffness (75%), and vomiting (62.5%). Overall, Cluster of differentiation 4 (CD4) T-lymphocytes count was <100 cells/μl except 1 case in which the CD4 T-lymphocytes count was 137 cells/μl. No concomitant cryptococcal and tubercular meningitis case was detected. All 16 patients responded initially to induction therapy of IV amphotericin B 1 mg/kg and fluconazole 800 mg daily for 2 weeks. Subsequently, 4 (25%) patients were lost for follow-up and 2 (12.5%) patients expired during their hospital stay. Conclusion: As the clinical and radiological pictures of CM are often non-pointing, routine mycological evaluation is necessary for early definite diagnosis and subsequent initiation of appropriate therapy as the majority of patients respond well to treatment if started early.
Keywords: CD4 T-lymphocytes, cryptococcal meningitis, Cryptococcus neoformans people living with human immunodeficiency virus/acquired immunodeficiency syndrome