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 ~  Abstract
 ~  Case report
 ~  Discussion
 ~  Acknowledgement
 ~  References

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CASE REPORT
Year : 2001  |  Volume : 19  |  Issue : 3  |  Page : 153-154
 

Cryptococcal meningitis in aids patients - A report of two cases


Department of Microbiology, Government Medical College, Amritsar, India

Correspondence Address:
Department of Microbiology, Government Medical College, Amritsar, India

 ~ Abstract 

A fiftyfive year old gentleman with HIV infection was investigated for meningitis.Cryptococcus neoformans was isolated.Second case was a lady of 42 years, with HIV infection, was also investigated for meningitis. Cryptococcus neoformans was isolated. Antigen was detected in CSF as well as serum in both the cases.

How to cite this article:
Arora U, Aggarwal A. Cryptococcal meningitis in aids patients - A report of two cases. Indian J Med Microbiol 2001;19:153-4


How to cite this URL:
Arora U, Aggarwal A. Cryptococcal meningitis in aids patients - A report of two cases. Indian J Med Microbiol [serial online] 2001 [cited 2019 Dec 11];19:153-4. Available from: http://www.ijmm.org/text.asp?2001/19/3/153/8152


Cryptococcus neoformans produces a chronic or subacute pulmonary, systemic or meningeal infection and is recovered, most frequently, from patients with immunosuppression. In patients with HIV infection it is one of the common causes of meningitis.[1] In India, though isolated cases of Cryptococcus have been reported from different centres,[2],[3],[4],[5] no case has been reported from in and around Amritsar. We are reporting two cases of Cryptococcal meningitis for the first time in acquired immunodeficiency syndrome(AIDS) patients from Govt. Medical College Amritsar .

 ~ Case report Top

Case 1
A fiftyfive year old man with HIV infection was admitted in the medical ward of Guru Nanak Dev hospital with complaints of headache, fever (38-38.50 C) and neck rigidity for the last 21 days. CSF obtained by Lumbar puncture was received in the department of Microbiology. Wet mount, Gram staining and India ink preparation revealed 4-7m, round budding yeasts with capsule and 8-10 lymphocytes per high power field. CSF was cultured by standard procedures.[6] Creamy white colonies were seen on Sabouraud dextrose agar medium. The identification and pathogenicity of Cryptococcus neoformans was established by growth at 370 C ,urease production and mouse pathogenicity test. Antigen detection was also done and titre ,both in CSF and serum, was 2048. The patient responded to antifungal treatment (amphoterecin B and fluconazol) within 3 days.
Case 2
Fortytwo years old lady (HIV positive) was admitted with chest infection, fever 380 C and headache for the last six weeks and neck rigidity for the last fifteen days. Wet mount, Gram staining and India ink preparation of the CSF showed 4-7m, round budding yeast cells with capsule. 5-6 lymphocytes were also seen per high power field. Culture on Sabouraud dextrose agar showed the growth of Cryptococcus. Identification and pathogenicity were established as in the above case. Both in serum and CSF, the antigen titre was done. Antigen titre in serum was 132 and in CSF it was more than 32. As this patient had chest infection, sputum was also cultured which was negative for Cryptococcus neoformans. Response to treatment is not known as the patient left against medical advice.

 ~ Discussion Top

After Cytomegalovirus, Pneumocystis carinii and Mycobacterium avium   intracellulare, Cryptococcus neoformans is the fourth commonest cause of life threatening infection in AIDS patients.[7] The incidence of Cryptococcal meningitis in HIV infected patients has been reported to be 3.6% in U.K, 4.5% in Southeast France,6-10 % in U.S.A. and 3% in India.[8],[9],[10],[11] With the advent of AIDS pandemic, cases of Cryptococcal meningitis would be on the rise. So,it seems that in patients with HIV infection, a high index of suspicion with full laboratory workup and early institution of treatment is required to improve survival.

 ~ Acknowledgement Top

We are thankful to Dr.H.C.Gugnani, Professor Department of Medical Microbiology at VBPICD University of Delhi, Delhi, for determining the antigen titre in the above cases. 

 ~ References Top

1.Dismukes WE. Cryptococcal meningitis in AIDS. J Infect Dis 1988; 57:624-8.  Back to cited text no. 1    
2.Chakrabarti A, Verma SC, Roy P, Sakhuja V, Chander J, Prabhakar S, Sharma BK. Cryptococcosis in and around Chandigarh, an analysis of 65 cases. Indian J Med Microbiol 1995;13:65-9.  Back to cited text no. 2    
3.Banerjee U, Khadka JB, Sethi S, Gupta K. Sudden spurt of Cryptococcosis at a tertiary care hospital in New Delhi between Dec.94 and Feb.95. Indian J Med Res 1995;102:272-4.  Back to cited text no. 3    
4.Aher AR,Gujrathi UP, Kulkarni SG, Sivarajan K, Kubnani A. Cryptococcal meninigitis. Indian J Med Microbiol 1996; 14:215-6.  Back to cited text no. 4    
5.Rajesh PK, Arvind BD, Ajit SD, Sunita MS, Anoopkumar RA, Sanjay RM. Cryptococcal meningitis in AIDS-a case report. Indian J Med Microbiol 1998;16:126-7.  Back to cited text no. 5    
6.Rippon JW. Medical Mycology- the pathogenic fungi and pathogenic Actinomycetes, 3rd ed (WB Saunders Co., Philadelphia)1988,Page 582.  Back to cited text no. 6    
7.Kovacs JA, Kovcacs AA, Polls M, Wright WC, Gill VJ, Tuazon CU, Gelmann EP, Lane HC, Longfidel R, Overturf G. Cryptococcus in the acquired immunodeficiency syndrome. Ann intern Med 1985;103(4) 533-8.  Back to cited text no. 7    
8.Sugar AM, Stern JJ, Dupont B. Overview : Treatment of Cryptococcal meningitis. Rev infect Dis 1990; 12(srppl) 5338-48.  Back to cited text no. 8    
9.Holmberg K, Meyer R. Fungal infections in patients with AIDS and AIDS related complex. Scand J Infect 1986; 18:179-92.  Back to cited text no. 9    
10.Murphy SA, Dennig DW. Cryptococcal meningoen-cephalitis in AIDS. Hospital update (20):151-6.  Back to cited text no. 10    
11.Specialist training and reference module. National AIDS control organisation New Delhi. Management of opportunistic infections in AIDS 1999; 114-7.  Back to cited text no. 11    
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