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Human immunodefeciency virus associated cryptococcal meningitis at a tertiary care centre: diagnostic tools and
Rashmi Munivenkataswamy1, Anjana Gopi, Shaik Mohammed Usman
1Consultant, Department of Microbiologist, Gokula Metro Polis Diagnostics , Bangalore, India .
Context:
Cryptococcal meningitis has emerged as a leading cause of the infectious morbidity and mortality in HIV sero-reactive subjects and it is the second most common cause of the opportunistic neuroinfections in it. As this is a indistinguishable from other causes of meningitis, its early diagnosis is the key to the therapeutic success.
Objectives:
This study was undertaken to know the incidence of Cryptococcal meningitis in HIV sero-reactive individuals and to assess the role of the microbiological parameters in its specific diagnosis, with a perspective of evaluating the anti-fungal resistance.
Material And Methods:
A total of 66 CSF samples from suspected cases of meningoencephalitis were subjected to standard microbiological procedures. The Cryptococcal isolates were identified by microscopy, the cultural characteristics, melanin production on Niger Seed agar, urea hydrolysis, the Nitrate assimilation test and by capsular antigen detection by latex agglutination. The Cryptoccal isolates were further biotyped by using Canavanine-Glycine-Bromothymol blue agar. The Minimum Inhibitory Concentrations (MIC) of Amphotericin B and Fluconazole for the isolates were detected.
Results:
The incidence of Cryptococcal meningitis in our study group was 18.2% (12/66). The Cryptococcal antigen was detected in all the 12 cases, whereas microscopy was positive only in 9 cases and Cryptococcus was isolated by culture in 10 cases. All the isolates were sensitive to Amphotericin B and 90% of the isolates were sensitive to Fluconazole. The CD4counts ranged between 22-138 cells /μl.
Conclusion:
A high incidence of Cryptococcal meningitis in HIV sero-reactive subjects necessitates the importance of a precise and an early microbiological diagnosis for better management of such subjects. Due to the growing concern of emerging drug resistance, the testing for the anti-fungal susceptibility has to be encouraged in all the cases.
Insights
Cryptococcal meningitis affects 18.2% of HIV-positive individuals. Early microbiological diagnosis and antifungal susceptibility testing are crucial for managing this opportunistic infection in HIV patients.
Area of Science:
- Infectious Diseases
- Neuroscience
- Mycology
Background:
- Cryptococcal meningitis is a major cause of illness and death in HIV-positive individuals, often presenting as an opportunistic neuroinfection.
- Early diagnosis is critical for successful treatment, as symptoms can mimic other forms of meningitis.
Purpose of the Study:
- To determine the incidence of Cryptococcal meningitis in HIV-positive individuals.
- To evaluate microbiological diagnostic methods for Cryptococcal meningitis.
- To assess antifungal resistance in Cryptococcal isolates from this population.
Main Methods:
- Analyzed 66 cerebrospinal fluid (CSF) samples from suspected meningoencephalitis cases.
- Employed microscopy, culture, melanin production, urea hydrolysis, nitrate assimilation, and latex agglutination for Cryptococcus identification.
- Determined Minimum Inhibitory Concentrations (MICs) for Amphotericin B and Fluconazole.
Main Results:
- The incidence of Cryptococcal meningitis was 18.2% (12/66).
- Cryptococcal antigen detection was positive in all 12 cases; microscopy and culture were positive in 9 and 10 cases, respectively.
- All isolates were susceptible to Amphotericin B, and 90% were susceptible to Fluconazole; CD4 counts ranged from 22-138 cells/μl.
Conclusions:
- The high incidence underscores the need for prompt and accurate microbiological diagnosis of Cryptococcal meningitis in HIV-positive patients.
- Antifungal susceptibility testing should be encouraged due to rising concerns about drug resistance.
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