Prevalence of Cryptococcal Meningitis among Immuno-competent and Immuno-compromised Individuals in Bellary,
South India: A Prospective Study
Kanchan Mahale, Satish Patil, Ravikumar, Nagabhushan, Ramanath Mahale
Assistant professor,Department of Microbiology,Srinivas
Institute of Medical Sciences and Research Centre, Surathkal,
Background and Objectives: Cryptococcal meningitis is now the leading cause of community acquired meningitis. It has generally been thought to be associated with individuals with AIDS. However, other predisposing factors like leukaemia, lymphoma, Diabetes mellitus, connective tissue disorders and organ transplantation also contribute to this infection. Cryptococcal meningitis also occurs in apparently immuno-competent individuals. Opportunistic infections are the major life threatening complications of the acquired immuno-deficiency syndrome (AIDS). An early diagnosis can help the clinician to treat cryptococcal meningitis and to thus help in reducing the rate of mortality. The present study was taken up to evaluate the occurrence of cryptococcal meningitis among immuno-compromised and immuno-competent individuals and also to analyze the predisposing factors which contribute to its occurrence.
Methods: A total of 242 CSF samples of clinically suspected cryptococcal meningitis were screened for Cryptococcus neoformans irrespective of their immune status. Their identification was based on direct microscopy, culture and biochemical reactions which were carried out by conventional methods. The CD4 cell count was obtained by flow cytometry in all the culture positive patients.
Results: The overall prevalence of cryptococcal meningitis was 8.3% and the prevalence of cryptococcal meningitis among the immuno-compromised patients was found to be 16.6%. 60% of the patients were in the age group of 21-40 years. Infection with HIV (100%) was the most common predisposing factor, followed by diabetes mellitus (40%), chronic smoking (20%) and prolonged steroid therapy (5%). Cryptococcus neoformans var. neoformans was the aetiologic agent in all the culture positives in our study. Cryptococcal meningitis was the AIDS defining illness in 50% of the patients. The mean CD4 count was 59.55. 65% of the patients had a CD4 count of <100.
Conclusion: The high prevalence of cryptococcal CNS infections in HIV infected patients underscores the importance of a precise and early microbiological diagnosis. A high index of clinical suspicion and mycological surveillance is required to help in an early diagnosis and appropriate therapy.
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