Shayanki Lahiri Mukhopadhyay
National Institute of Mental Health and Neuro Sciences, India
Title: Infection of the central nervous system due to Cryptococcus spp. complex: An analysis from a tertiary neuro care-centre in south India
Biography
Biography: Shayanki Lahiri Mukhopadhyay
Abstract
Background & Aim: Cryptococcus neoformans sensu lato, and its sister species C. gattii sensu lato often cause meningitis or meningoencephalitis among immunocompromised patients. We aimed to analyse the clinical and epidemiological features of cryptococcal CNS infection.
Methods: The study was conducted from 2013 to 2015, including 160 cases of CNS infection due to C. neoformans/gattii. The variables documented were age, gender, immunological status, associated comorbidities, brain-imaging features, CSF parameters and geographical distributions, treatment and outcome. Diagnosis was based on Indian ink preparation, cryptococcal antigen detection and culture. Statistical analysis was performed by Chi Square exact test in SPSS 22.0 to determine the P values.
Results: Out of 160 cases studied 128 (80%) were HIV positive. Among the 32 (20%) HIV negative cases 17 (53.1%) had history of immunosuppression. Age group ranged from 2 to 75 years, with mean age of 37.5 years (σ=9.83) among HIV positive and 36.68 years (σ=29.16) among HIV negative cases. Other than HIV, tuberculosis was the most common associated comorbidity (28.12%). Headache was predominant complaint (88.8%) followed by vomiting (61.9%), fever (60%), neck stiffness (55.6%). Imaging features were normal in 57 (35.6%) cases followed by presence of hypodense parenchyma (20.6%), meningeal enhancement (18.8%), cortical atrophy (15.6%), and cryptococcal lesion (9.4%). Parameters including neck stiffness (P=0.021), muscle weakness (P=0.046) polymorphonucleocyte predominance in CSF (P=0.012), low sugar (P=0.038) and high protein (P=0.003) levels in CSF were significantly different among HIV positive and negative cases. Out of 160 isolates, 142 were C. neoformans s.l. (VNI, VNII) and 18 were C. gattii s.l. (VGI, VGIV, VGIII). Statistical analysis showed molecular type of cryptococcal isolates were dependent on immune status of the patients (P=0.00001).
Conclusion: This study investigates the clinical aspects of cryptococcal infection among Indian patients and contributes to better prognosis and treatment.