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Think fungus NOT just a crypto-meningitis in AIDS!

Amit Badiye1, Mrinal Patnaik, Alaka Deshpande

  • 1HIV Medicine, Sir JJ Hospital, Mumbai.

The Journal of the Association of Physicians of India
|June 21, 2013
PubMed
Abstract

Insights

Cryptococcal meningitis is common in advanced HIV. This study found that other fungi, like Rhodotorula, also cause meningitis in these patients, not just Cryptococcus neoformans.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Immunology

Background:

  • Extrapulmonary cryptococcosis is an AIDS-defining illness in HIV-infected individuals.
  • Cryptococcal meningitis is the most frequent meningitis in patients with advanced immune deficiency.
  • Relying solely on Cryptococcus detection tests can be misleading.

Purpose of the Study:

  • To investigate the spectrum of fungal meningitis in HIV-positive patients.
  • To evaluate the utility of cerebrospinal fluid (CSF) fungal culture in diagnosing fungal meningitis.
  • To identify fungal pathogens beyond Cryptococcus in HIV-associated meningitis.

Main Methods:

  • A prospective study involving 70 ART-naive HIV cases with suspected fungal meningitis.
  • Cerebrospinal fluid (CSF) analysis included cytochemistry, smear examination, and fungal culture.
  • Patients were evaluated for various fungal species causing meningitis.

Main Results:

  • CSF fungal culture was positive in 75.6% of suspected cases.
  • Cryptococcus neoformans was identified in 21 cases, while Rhodotorula was found in 28 cases.
  • Other fungi isolated included Candida, Aspergillus, Geotrichum, and Trichosporon.

Conclusions:

  • Fungal meningitis in HIV patients can be caused by various fungi, not exclusively C. neoformans.
  • CSF fungal culture is crucial for accurate diagnosis and management of suspected fungal meningitis.
  • Early empirical treatment with Amphotericin is recommended if fungal infection is suspected and culture facilities are unavailable.

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