Prevalence of cryptococcal meningitis in a tertiary care centre (original) (raw)
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AFRICAN JOURNAL OF BIOTECHNOLOGY, 2012
Fungi are common in human immunodeficiency virus (HIV)-positive patients but HIV predisposes patients to several viral and bacterial infections that can result in meningitis. Understanding the burden of cryptococcal disease is particularly important for public health officials to adequately plan and prioritize needed resources for disease prevention and control. Cryptococcal meningitis, a fungal infection caused by Cryptococcus spp. is the second most common cause of opportunistic fungal infection in patients with acquired immunodeficiency syndrome (AIDS). It is important to define the burden of cryptococcal meningitis, as it relates to other important diseases, and to understand the need for public health attention to this infection. Frequently, HIV infection weakens the body's ability to fight disease. Infections which are rarely seen in those with normal immune systems are life-threatening to those with HIV. It is time to expand this global focus on HIV to include one of its most serious consequences, cryptococcosis. Few, if any, complications of advanced HIV disease have a greater influence on morbidity and mortality. We are likely to see little real progress in the outcome for these patients until there is a global commitment to invest in more drug availability, better access to easily used diagnostics and therapeutic devices, and more innovative clinical researches.
Cryptococcus Meningitis, in the Patients with Human immunodeficiency Virus Infection
International Journal of Pharmaceutical Science Invention, 2014
AIDS have given more importance to cryptococcosis,which was discovered a century ago.Cryptococcus neoformans is the most frequent cause of meningitis in HIV infected patients. Cryptococcus can infect any organ in the human body, the frequent sites are lung,CNS,skin,eye and prostrate The impact of capsular polysaccharide,melanin and ability to grow at higher temperature, in host immunity can be profound at pathophysiologic levels.Cryptococcal meningitis presentation in AIDS patients may be very subtle, with headache,fever,and lethargy. Meningeal signs occurs in some patients, photophobia and cranial nerve palsies are often absent, most patients have CD4 T-cell lower than 50 cells/µl.African patients have higher rate of neurologic compromise. Strong cellular immune response producing granulomatous inflammation is essential for containment of infection. Pathophysiology of cryptococcosis is similar to reactivation of tuberculosis, and histoplasmosis.Diagnostic methods include, direct microscopic examination by India ink mixing of biologic fluids, detection of polysaccharide antigen and a positive blood culture. Treatment of choice in AIDS patients with cryptococcal meningitis with amphotericin B with flucocytosine or fluconazole for 4 to 6 weeks Monotherapy cannot be recommended for the treatment of this infection.
Clinical Manifestations of Cryptococcal Meningitis in HIV Negative Patients-A Case Study
Cryptococcal Meningitis (CM) is a central nervous system infection caused by a fungus. A large majority of cases are caused by Cryptococcus neoformans var. neoformans. The fungus C. neoformans is found in soil that contains bird droppings, particularly pigeon excreta, all over the world. Cryptococcusneoformans var. gatti, on the other hand, is found primarily in tropical and subtropical regions trees, most commonly eucalyptus trees. It grows in the debris around the trees' bases. Cryptococcal meningitis usually occurs in people who have a compromised immune system and is a rare occurrence in someone who has a normal immune system. Of the two fungi, Cryptococcalgattii is the one more likely to infect someone with a normal immune system.The incidence of infections caused by C.neoformans has risen markedly over the past 20 years as a result of the HIV/AIDS epidemic and increasing use of immunosuppressive therapies. Cryptococcal meningitis is a common opportunistic infection and an AIDS-defining illness in patients with late-stage HIV infection, particularly in Southeast Asia and Southern and East Africa. It is widely considered as the most common life-threatening AIDS related fungal infection. Cryptococcal meningitis has been estimated at about 70 to 90% worldwide in AIDS patients with mortalities of between 50% to 70% in Sub-Saharan Africa. [2,3,4] Mortality from HIV-associated cryptococcal meningitis remains high (13–33%), even in developed countries, because of the inadequacy of current antifungal drugs and combinations, and the complication of raised intracranial pressure.[2,7,8]In the cases presented, the findings were so non-specific that the diagnosis was highly dependent on the CSF findings. Based on the characteristics of the presenting signs and symptoms, Cryptococcal meningitis should always be included in the differential diagnosis of chronic or subacute meningoencephalitis, since clinical features are not specific.
Journal of clinical and diagnostic research : JCDR, 2012
Cryptococcus neoformans is a ubiquitous encapsulated yeast that causes significant infections which range from asymptomatic pulmonary colonization to the life threatening meningoencephalitis, especially in immunocompromised individuals. Cryptococcal meningitis is one of the AIDS-defining illnesses. Recent data have indicated that, the incidence of the cryptococcal infection is high in developing countries like India. We conducted this study to find out the incidence of cryptococcosis in this area. The Cerebrospinal Fluid (CSF) specimens were collected from known HIV positive cases that had a clinical diagnosis of meningitis and they were processed by standard microbiological procedures. The cryptococcal isolates were identified by microscopy, their cultural characteristics, sugar assimilation and by the hydrolysis of urea. The incidence of cryptococcal meningitis was 12.9%. All the strains were susceptible to amphotericin B, fluconazole, itraconazole and voriconazole. The cryptococc...
Cryptococcal infection in patients with clinically diagnosed meningitis in a tertiary care center
Neurology India, 2003
A retrospective analysis of 326 clinically diagnosed cases with meningitis over a period of five-and-a-half years was carried out to determine the prevalence of cryptococcal infection, its associated risk factors and therapeutic outcome. Fifty-four (16.6%) patients with cryptococcal meningitis were identified by smear examination, culture and/or cryptococcal antigen latex agglutination test. Records of 45 cryptococcal meningitis patients were available; 18 (40%) of them were apparently healthy immunocompetent individuals, 13 (28.9%) had human immunodeficiency virus (HIV) infection, 9 (20%) were renal transplant recipients, 4 (8.9%) were diabetic and 1 (2.2%) had systemic lupus erythematosus. Ten (22.2%) patients died and 11 (24.4%) patients (all HIV-positive) left against medical advice. The present study indicates that cryptococcal infection is associated with high mortality. Presenting symptoms being indistinguishable from other causes of central nervous system infection, all pati...
Cryptococcal Meningitis in a Newly Diagnosed AIDS Patient: A Case Report
West African Journal of Medicine, 2010
BACKGROUND: Cryptococcus neoformans is a very important cause of fungal meningitis in immunosuppressed patients OBJECTIVE: To describe a case of cryptococcal meningoencephalitis in an HIV/AIDS patient from the University of Ilorin Teaching Hospital. METHODS: An 18-year-old male student presented with cough, weight loss, and fever. He was clinically assessed and had full laboratory investigations including cerebrospinal fluid CSF and then started on chemotherapy. Both the clinical and neurological evaluation of the patient was described along with the laboratory analyses of his CSF. Outcome of how he was managed was also reported. RESULTS: Cryptococcus neoformans presented as an AIDS defining fungal infection for the first time in this 18 year old undergraduate who was infected probably from transfusion of unscreened blood He had advanced HIV infection (CD4+ count of 29cells/ul) and severe cryptococcal meningoencephalitis. He was unsuccessfully managed with fluconazole, a second choice drug for this condition, amphotericin B being not available. CONCLUSION: Nigerians should have access to effective blood transfusion services at all public and private hospitals across the country. The National Essential Drug list should be expanded to include drugs such as amphotericin B which hitherto were considered exotic. WAJM 2009; 28(5): 343-346.
Cryptococcal Meningitis in HIV Patients and Its Management
https://ijshr.com/IJSHR\_Vol.4\_Issue.3\_July2019/IJSHR\_Abstract.008.html, 2019
Cryptococcal meningitis is infectious disease and has emerged as a number one reason for infectious morbidity and mortality in patients with AIDS. Among the human immunological disorder virus (HIV)-seropositive subjects, cryptococcal infectious disease is that the second commonest cause of opportunistic neuro-infection. Cryptococcal infectious disease happens in non-HIV patients who are immunodeficient due to diabetes, cancer, solid organ transplants, chemotherapeutic drugs, hematological malignancies etc and rarely in healthy individuals with no obvious predisposing factors. Diagnosis of cryptococcal infectious disease is fairly simple once the diagnosing is considered in the differential diagnosis of chronic infectious disease. Treatment of a patient with cryptococcal infection is a challenge for both the physician and the patient, but rewarding, as many would recover with timely and adequate antifungal therapy. Keywords: Cryptococcal meningitis, HIV, AIDS
Southern African Journal of Hiv Medicine, 2013
Six years after the first Society guidelines were published, cryptococcal meningitis (CM) remains an important cause of morbidity and mortality among HIV-infected adults in South Africa. Several important developments have spurred the publication of updated guidelines to manage this common fungal opportunistic infection. Recommendations described here include: (1) screening and pre-emptive treatment; (2) laboratory diagnosis and monitoring; (3) management of a first episode of CM; (4) amphotericin B deoxycholate toxicity prevention, monitoring and management; (5) timing of antiretroviral therapy among patients with CM; (6) management of raised intracranial pressure; (7) management of relapse episodes of CM.
Cryptococcal Meningitis Associated Hiv Infection in the Donka National Hospital in Conakry (Guinea)
African Journal of Neurological Sciences
ABSTRACT Background Cryptococcal meningitis (CM) is an infection of the brain parenchyma and subarachnoid space by the encapsulated saprophyte yeast organisms such as Cryptococcus neoformans. Over the last twenty years, HIV has created a large and severely immune compromisized population in whom C. neoformans is a dangerous opportunistic infection. In Guinea, the prevalence of CM is unknown. We hypothesized that the occurrence of CM correlates with AIDS/ HIV prevalence. Method This retrospective observational study was carried out at the national Hospital of Conakry (Guinea) between 2001 and 2002. We describe here the epidemiological and clinical and biological characteristics of CM disease in our national hospital. Results Our data show that, 28.6 % of HIV patients with neurological symptoms had Cryptococcus neoformans in their CSF by using Indian ink staining. The median age was 36±3 years and sex ratio (M/F) was 1.8. The major complaints were fever and cephalgia, giddiness while ...