Cryptococcal Meningitis in HIV Patients from a Tertiary Care Centre in Northern India

Introduction: Cryptococcal meningitis, caused by Cryptococcusneoformans, an opportunistic fungal infection that affectsimmunocompromised Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) patients. In recentyears, the incidence of cryptococcal meningitis has increased inboth the HIV-positive and HIV-negative patients; therefore thereis a need for development of efficient methods for early diagnosisand treatment to reduce mortality and morbidity.Aim: To determine the incidence of cryptococcal meningitisin HIV/AIDS patients and to compare the results of latexagglutination test and India ink preparation with fungal cultureexamination.Materials and Methods: A total of 204 Cerebrospinal fluid(CSF) samples from HIV-positive patients (aged >18 years)showing signs and symptoms of meningitis were collected. Thesamples were cultured on Sabouraud's Dextrose Agar (SDA),and analysed using India ink preparation and cryptococcalantigen detection by the rapid Latex Agglutination assay.Results: Mean age of the patients was 32.45 years. The male:female ratio was observed to be 10:1. Of these, 30 (14.70%)cases were culture positive, 35 (17.15%) were positive forcryptococcal antigen and 16 (7.84%) patients were found tobe positive by India ink preparation. Incidence of cryptococcalmeningitis was observed to be 14.70% in the study population.Considering culture as gold standard, the sensitivity andspecificity of India ink was observed to be 53.33% and 100%respectively. The antigen detection test showed the sensitivityand specificity of 100% and 97.12%, respectively.Conclusion: Rapid and early diagnosis of cryptococcalinfection by detection of the fungal antigen in CSF of patientsby latex agglutination when compared to culture and India inkcan alter the course of management of cryptococcal meningitispatients.