title: Cryptococcal meningitis in HIV infected: experience from a North Indian tertiary center.
abstract: BACKGROUND
  Cryptococcal meningitis is a common opportunistic infection in Human Immunodeficiency Virus (HIV)-infected individuals. There is little information specifically addressing cryptococcal meningitis in HIV-infected patients from North India.
  
  
  OBJECTIVE
  To determine clinical presentation, hospital course, response to treatment, complications developed, in-hospital mortality, any recurrence of cryptococcal meningitis and reasons of recurrence during follow-up.
  
  
  METHODS
  A retrospective observational study undertaken in a large tertiary care center.
  
  
  METHODS
  Patient's demographic data, presenting clinical symptomatology, physical findings, laboratory parameters, cerebrospinal fluid (CSF) examination findings, side-effects of treatment, development of any complications and hospital outcome were analyzed. During follow-up any recurrence of cryptococcal meningitis, possible reasons of recurrence, type of treatment received, complications developed and outcome was recorded as well.
  
  
  RESULTS
  Forty patients diagnosed to have cryptococcal meningitis were analyzed. Twenty-two (55%) patients had acute/ subacute presentation. Thirty-six (90%) patients presented with headache and 18 (45%) had altered sensorium. Twenty (50%) patients had no cells in the CSF. Hypoglycorrhchia was seen in 30 (75%) patients. Cryptococcal meningitis was the first acquired immune deficiency syndrome (AIDS)-defining illness in 30 (75%) patients. Thirty-five patients developed some adverse effects to amphotericin-B. Thirty-three patients improved with treatment while three patients died. Four patients had recurrence of cryptococcal meningitis within six months of first episode. Non-compliance of fluconazole therapy was the reason for recurrence in all of these patients.
  
  
  CONCLUSIONS
  Cryptococcal meningitis is a common initial AIDS-defining illness. Acute and/or subacute presentation of cryptococcal meningitis is not uncommon in HIV-infected individuals. An early diagnosis of HIV infection might reduce the incidence of this infection.
authors.affiliation: Department of Internal Medicine, PGIMER, Chandigarh, India.
authors.forename: Susheel
authors.initials: S
authors.lastname: Kumar
authors.forename: Ajay
authors.initials: A
authors.lastname: Wanchu
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
authors.forename: Aman
authors.initials: A
authors.lastname: Sharma
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bambery
authors.forename: Surjit
authors.initials: S
authors.lastname: Singh
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D016919:Meningitis, Cryptococcal / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D012189:Retrospective Studies