Cryptococcal Meningitis in HIV Patients from a Tertiary Care Centre in Northern India

摘要

Introduction: Cryptococcal meningitis, caused by Cryptococcus neoformans, an opportunistic fungal infection that affects immunocompromised Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) patients. In recent years, the incidence of cryptococcal meningitis has increased in both the HIV-positive and HIV-negative patients; therefore there is a need for development of efficient methods for early diagnosis and treatment to reduce mortality and morbidity. Aim: To determine the incidence of cryptococcal meningitis in HIV/AIDS patients and to compare the results of latex agglutination test and India ink preparation with fungal culture examination. Materials and Methods: A total of 204 Cerebrospinal fluid (CSF) samples from HIV-positive patients (aged 18 years) showing signs and symptoms of meningitis were collected. The samples were cultured on Sabouraud's Dextrose Agar (SDA), and analysed using India ink preparation and cryptococcal antigen detection by the rapid Latex Agglutination assay. Results: Mean age of the patients was 32.45 years. The male: female ratio was observed to be 10:1. Of these, 30 (14.70%) cases were culture positive, 35 (17.15%) were positive for cryptococcal antigen and 16 (7.84%) patients were found to be positive by India ink preparation. Incidence of cryptococcal meningitis was observed to be 14.70% in the study population. Considering culture as gold standard, the sensitivity and specificity of India ink was observed to be 53.33% and 100% respectively. The antigen detection test showed the sensitivity and specificity of 100% and 97.12%, respectively. Conclusion: Rapid and early diagnosis of cryptococcal infection by detection of the fungal antigen in CSF of patients by latex agglutination when compared to culture and India ink can alter the course of management of cryptococcal meningitis patients.