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Cryptococcal meningitis, caused by Cryptococcus neoformans, is an opportunistic fungal infection that mainly affects HIV, immunocompromised patients. C. neoformans, often found in soil, is a free-living environmental microbe that does not require a host to reproduce or survive. Its key virulence factors include the polysaccharide capsule and cell wall associated melanin [1]. Over the past decade, the incidence of cryptococcal meningitis has increased in both immuno-compromised and immuno-competent patients. Recent study by Rajasingham R et al., estimated an average global cryptococcal antigenemia prevalence of 6.0% among people with a CD4+ cell count of less than 100 cells per μL and the disease was responsible for 15% of AIDS-related deaths [2]. Cryptococcosis is the second most common fungal infection after candidiasis in HIV-patients and cryptococcal meningitis is the fourth most commonly recognised cause of life-threatening infection among AIDS patients [3]. Thus, the magnitude of the disease is worth a concern. Diagnosing cryptococcal meningitis is convoluted, as the meningeal signs are not predominantly revealed in HIV patients and the CSF may appear normal with glucose and protein levels within range. Conventional method such as fungal culture is specific, but time consuming and is limited by culture conditions and amount of CSF [4]. India ink staining is rapid but lacks sensitivity and is subjective to technician skill set, and latex agglutination test is highly sensitive and specific and helps in evaluating both severity and prognosis of illness. Rapid diagnosis is essential for prompt therapy to manage fatality rates.

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