Cryptococcal meningitis in a large cohort from India

      Background and objective: Cryptococcal meningitis is an important and a fatal neuroinfection. Early diagnosis and treatment is of utmost importance in reducing morbidity and mortality.
      Methodology: Data of patients with laboratory confirmed cryptococcal meningitis seen over 13 years in the tertiary care hospital were reviewed. Details of demographic profile, clinical data, laboratory parameters, complications and in-hospital mortality were studied.
      Results: There were 97 patients with cryptococcal meningitis (79 men, 18 women) of whom 88 were HIV positive, one was diabetic and 8 were sporadic. Their age ranged from 23 to 67 years (39.16 ± 9.49). Additional pathogens for meningitis were identified in 24 patients. Headache was the most common symptom (91%) followed by fever (66%), vomiting (51%), altered sensorium (31%) and seizures (20%). Neurological deficits included cranial nerve palsies (28), motor deficits (11), sphincter disturbances (5) and sensory involvement in 4 patients. Antifungal treatment consisted of amphotericin (78), fluconazole (16) and voriconazole (1). Two did not receive treatment. Complications included renal dysfunction (20%), dyselectrolytemia (20%), seizures (16%), hypersensitivity (7%) and hepatic dysfunction (5%). Favorable outcome was seen in 72 patients; 13 remained unchanged and 12 died. Rapid clinical progression, low CSF cell count and low CSF were associated with higher mortality. CSF cell count and protein were lower in patients who had isolated cryptococcal meningitis compared to those with additional tubercular meningitis. Mean sugar levels were higher and duration of illness was shorter in HIV negative individuals.
      Conclusion: Cryptococcal meningitis is common in patients with AIDS. Effective and early antifungal treatment carries good prognosis. Shorter duration of illness, decreased CSF cell count and protein herald poor prognosis and warrants initiation of early specific treatment.