Clinical Profile of Cryptococcal Meningitis in Patients Living with HIV Infection: An Experience from Western India

Abstract

Background: Cryptococcal meningitis (CM) is an important public health problem, and causes around 10%–30% mortality among people living with HIV/acquired immune deficiency syndrome (AIDS). Combination therapy with Amphotericin B and Fluconazole has improved the outcomes. Objectives: The purpose of this study is to determine clinical presentation, hospital course, response to treatment, complications, and recurrence of CM. Materials and Methods: An observational study from a tertiary care center. From the diagnosed cases of CM, demographic data, clinical profile, investigations, treatment received, complications, and recurrence on follow-up were noted. Results: Twenty patients diagnosed to have CM with HIV infection were analyzed. 12 patients (60%) had CM as the presentation of AIDS. The prevalence of unmasked immune reconstitution inflammatory syndrome (IRIS) (30%) was more than paradoxical IRIS (10%). Fever (85%), headache (90%), and altered sensorium (40%) were the most common symptoms. Mean CD4 in our study was 119.3. Cerebrospinal fluid (CSF) analysis showed oligocellular response in 12 patients. CSF cryptococcal antigen test and fungal culture were positive in all cases. Most common finding on neuroimaging was meningeal enhancement (60%) followed by cryptococcomas (26%). 17 patients survived, whereas 3 patient died during treatment. Three patients had relapse of CM, all of them were noncompliant to maintenance fluconazole therapy. Conclusion: Considering variable presentation of CM in HIV-infected individuals and the presence of high load of undiagnosed cases, high suspicion is required for clinching early diagnosis which might improve the outcome.

Keywords

• Acquired immune deficiency syndrome
• cerebrospinal fluid
• cryptococcal meningitis
• HIV