title: Changing paradigm of cryptococcal meningitis: an eight-year experience from a tertiary hospital in South India.
abstract: BACKGROUND
  Cryptococcal meningitis (CM) is a common opportunistic fungal infection causing sub-acute meningitis with the potential for complications and significant mortality. We conducted this study to describe the difference in presentation and outcome between HIV-infected and HIV-uninfected patients.
  
  
  METHODS
  Patients admitted to a tertiary care centre between 2005 and 2013 with confirmed CM were included in the analysis. Details of the clinical presentation, laboratory findings, treatment details, risk factors for infection and outcome were documented and analysed.
  
  
  RESULTS
  During the study period, 102 (87.2%) cases of CM occurred among HIV infected individuals, whereas 15 (12.8%) occurred among HIV-uninfected patients. HIV-infected patients with CM were younger compared with HIV-uninfected patients (38.2 ± 8.5 years vs. 45 ± 11.5 years; P = 0.07). The median duration of symptoms prior to presentation was shorter in the HIV-infected group (20 ± 32 vs. 30 ± 42; P = 0.03). There was no difference between the cerebrospinal fluid (CSF) lymphocyte counts, CSF protein counts, and CSF sugar levels in both the groups. The diagnostic yield of Cryptococcus was similar with CSF India ink smear (89% vs. 87%), CSF fungal culture (95% vs. 87%), and blood culture (100% vs. 75%) in both the groups. Case fatality rate in the HIV-infected group was 30.6%, whereas there were no deaths in the HIV-uninfected group.
  
  
  CONCLUSIONS
  HIV-infected patients with CM have a worse outcome compared to HIV-uninfected patients. The overall trend over 3 decades shows increasingly successful rates of treatment and hence early diagnosis and treatment are of paramount importance.
authors.affiliation: Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: K P P
authors.initials: KP
authors.lastname: Abhilash
authors.forename: S
authors.initials: S
authors.lastname: Mitra
authors.forename: J J J
authors.initials: JJ
authors.lastname: Arul
authors.forename: P M
authors.initials: PM
authors.lastname: Raj
authors.forename: V
authors.initials: V
authors.lastname: Balaji
authors.forename: R
authors.initials: R
authors.lastname: Kannangai
authors.forename: S A
authors.initials: SA
authors.lastname: Thomas
authors.forename: O C
authors.initials: OC
authors.lastname: Abraham
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000737:chemistry / Q000166:cytology; D003454:Cryptococcus / Q000302:isolation & purification*; D003955:Diagnostic Tests, Routine; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007194:India; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D008828:Microbiological Techniques; D008875:Middle Aged; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents