Abstract:
Background and objectives: Cryptococcal meningitis is now
the leading cause of community acquired meningitis. It is gener-
ally thought to be associated with AIDS individuals. However,
other predisposing factors like leukemia, lymphoma, Diabetes
mellitus, connective tissue disorders and organ transplantation
also contribute to the infection. Cryptococcal meningitis also oc-
curs in apparently immunocompetent individuals. Opportunistic
infections are the major life threatening complications of the ac-
quired immunodeficiency syndrome (AIDS). Early diagnosis can
help the clinician to treat cryptococcal meningitis and thus help
in reducing the rate of mortality .The present study was taken
up to study the occurrence of cryptococcal meningitis among
the immunocompromised and immunocompetent individuals
and also to analyse the predisposing factors in relation to its
occurrence.
Methods: A total of 242 CSF samples of clinically suspected
cryptococcal meningitis were screened for Cryptococcus neo-
formans irrespective of their immune status. Identification was
based on direct microscopy, culture and biochemical reactions
by conventional methods. CD4 cell count was performed by flow
cytometry in all culture positive patients. The overall prevalence
of cryptococcal meningitis was 8.3% and the prevalence of cryp-
tococcal meningitis among immunocompromised 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%), chron-
ic smoking (20%) and prolonged steroid therapy (5%). Crypto-
coccus neoformans var. neoformans was the etiologic agent in
all the culture positives in our study. Cryptococcal meningitis
was 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.
High prevalence of cryptococcal CNS infections in HIV infected
patients underscores the importance of precise and early mi-
crobiological diagnosis. A high index of clinical suspicion and
mycological surveillance is required to help in an early diagnosis
and appropriate therapy.
