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 ~  Abstract
 ~  Materials and Me...
 ~  Results
 ~  Discussion
 ~  Conclusion
 ~  Acknowledgements
 ~  References

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Year : 2001  |  Volume : 19  |  Issue : 3  |  Page : 157-158
 

Cryptococcal meningitis among HIV infected patients


Department of Microbiology, Perundurai Medical College, Perundurai - 638 053, Tamilnadu, India

Correspondence Address:
Department of Microbiology, Perundurai Medical College, Perundurai - 638 053, Tamilnadu, India

 ~ Abstract 

Cryptococcal meningitis is an emerging opportunistic infection among HIV infected patients and an important cause of mortality among these patients. The incidence of cryptococcal meningitis varies from place to place. A total of 31 specimens of CSF out of 89 samples processed from known HIV positive cases yielded Cryptococcus neoformans during the period of 3 years. C.neoformans was the most common opportunistic pathogen isolated from CSF samples of these patients with an incidence of 34.8%

How to cite this article:
Manoharan G, Padmavathy B K, Vasanthi S, Gopalte R. Cryptococcal meningitis among HIV infected patients. Indian J Med Microbiol 2001;19:157-8


How to cite this URL:
Manoharan G, Padmavathy B K, Vasanthi S, Gopalte R. Cryptococcal meningitis among HIV infected patients. Indian J Med Microbiol [serial online] 2001 [cited 2019 Aug 26];19:157-8. Available from: http://www.ijmm.org/text.asp?2001/19/3/157/8154


C.nenoformans is an opportunistic fungal infection and is the presenting manifestation of AIDS in about a third of these patients. It is the fourth most commonly recognized cause of life threatening infection among these patients. Infection of the brain and meninges is the most common clinical manifestation of cryptococcosis and the most common cause of death from that disease. Early cases with no symptoms referable to the CNS may have a positive culture of CSF with no other abnormality of the fluid.[1]
The present work is a retrospective study of laboratory records of cases of cryptococcal meningitis diagnosed during a period of three years from January 1998 to December 2000.

 ~ Materials and Methods Top

CSF samples from all clinically suspected meningitis cases received for microbiological analysis constituted the study material. All the samples of CSF were processed for routine bacterial culture, mycobacterial culture and fungal culture after preliminary microscopic examination of the sample comprising of wet mounts, India ink, Gram stain and Z.N. stain. Routine bacterial cultures were followed up for 72 hrs. and mycobaterial cultures for 6 weeks and fungal cultures for 4 weeks. C.neoformans was identified based on yeast like colony morphology, spherical yeast cells without hyphae/psesudohyphae by microscopy, a negative germ tube test, failure to ferment sugars, viz, Glucose, Lactose, Maltose, Sucrose, a positive urease test, and brown colonies on Niger seed agar and/ or mice pathogenicity test.

 ~ Results Top

A total of 161 samples of CSF were processed for bacterial and fungal culture during the study period comprising of 89 from known HIV positive cases and 72 from Non HIV cases. Out of the 89 samples from known HIV positive cases 31 samples yielded C.neoformans. Out of 31 cultures 11 were positive both by microscopy (ie, India Ink and Gram stain) and culture while 20 cases were positive by culture alone. The highest incidence of cryptococcal isolation was (16/31) in the 30-40 age group and male patients were predominantly affected (29/31)

 ~ Discussion Top

Cryptococcal meningitis is an opportunistic infection by the yeast C.neoformans. The incidence of Cryptococcal meningitis varies from place to place. The incidence of Cryptococcal meningistis among HIV cases in our study is 31/89 (34.8%) which is higher than or comparable to other reports (Ayyagiri et al [2] 5.6%, Bogaerts et al 3 19%, Rakhmanova et al [4] 17%, Silva Rosa et al [5] 45.8%).
Thus, the incidence of Cryptococcal meningitis has been found to be very high in our region and was the most common opportunistic pathogen isolated frosm CSF among all the pathogens put together, ie,pyogenic, non-pyogenic bacterial and fungal infections. The other oraganisms isolated from CSF samples of HIV positive cases included M.tuberculosis (5/89), Pseudomonas aeruginosa (2/89), and Candida other than albicans (1/89). Dual infection was noted in one case with C.neoformans and M.tuberculosis being isolated from the same specimen

 ~ Conclusion Top

Cryptococcal infection should be suspected in all cases of meningitis among HIV infected persons. Early diagnosis and treatment may alter the prognosis for these patients and hence examination of CSF should be considered in all HIV infected persons with symptoms of meningitis.

 ~ Acknowledgements Top

Dr. V Ramalingam, DEAN, PMC, Perundurai for permitting to submit the article for publication, and Mr. Thirunavukkarasu, Mr. Kolanjiappan. Mrs. L Priya, Lab Technicians for their valuable technical assistance. 

 ~ References Top

1.KJ Kwon- Drung: John E.Bennett, Medical Mycology Lea & Febiser 1992, 396-439.  Back to cited text no. 1    
2.Ayyagiri A, Sharma AK , Prasad KN, Dhole TN, Kishore J, Choudhary G. Spectrum of opportunistic infections in human immunodeficiency Virus (HIV) infected cases in a tertiary care hospital . Indian J Med Microbiol 1999; 17(2): 78-80.  Back to cited text no. 2    
3.Bogaerts J, Roueroy D, Taelman H, Kagame A, Aziz MA, Swinned VJ. AIDS associated Cryptococcal meningitis in Rwanda (1983-92) Epidemiological and diagnostic features. J infect.1999; 39 (3): 329-31.  Back to cited text no. 3    
4.Rakhmanova AG, Ciamgieva OKH. Clinical course of Cryptococcosis in HIV infections. KLIN Med (MOSK) 1999; 77(1) : 39-42.  Back to cited text no. 4    
5.Roses SC, Agania A, Eruns M et al. Meningitis subjects with HIV infection. Bull Soc Pathol Exot 1999; 92(1): 23-6.  Back to cited text no. 5    
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