1. Cryptococcal Meningitis in HIV Positive and HIV Negative Patients: Sixteen Years Study from Nimhans, Bangalore.
- Author
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Gadre, G., Satishchandra, P., Nalini, A., Mahadevan, A., Nagarathna, S., Chandramukhi, A., Desai, A., Ravi, V., Jayakumar, P. N., Subbakrisna, D. K., and Shankar, S. K.
- Subjects
MENINGITIS ,HIV-positive persons ,HEADACHE ,DISEASE complications ,MORTALITY - Abstract
Objective: To compare the clinical, CSF and radiological profile of cryptococcal meningitis, in HIV seropositive and seronegative subjects. Design: Retrospective, descriptive study. Materials and Methods: The study was carried out using the case records of all the patients evaluated by the department of Neurology, NIMHANS, during the period 1989-2005. Results: A total of 362 CSF culture positive cryptococcal meningitis were evaluated during this period at NIMHANS, Bangalore. 335 were HIV seropositive while 27 were seronegative (Ratio: 12.4:1). Age at onset ranged from 6-78 years, M: F ratio was 7:1 in seropositive and 4.4:1 in seronegative patients. Mean duration of neurological illness was 41.9 days (range=1-180 days). Headache was presenting complaint in 90% of the patients. 40% had severe disabling headache, mimicking that of subarachnoid hemorrhage. Fever (78.5% v/s 63%), vomiting (68.2% v/s 55%), altered sensorium (48.8% v/s 37%), seizures (27.7% v/s 8%), cranial nerve palsies (14% v/s 25%), hemiparesis (9% v/s 22%), visual loss (9% v/s 29%), behavioral abnormalities (9% v/s 18.5%), were other manifestations in seropositive and seronegative patients respectively. This demonstrates that complications are more commonly seen among sero -ve subjects. CT (brain) in +ve patients, showed normal (43.3%) or diffuse cerebral atrophy (28.1%) while in seronegative patients, CT was normal in 50% and hydrocephalus was seen in 25%. CSF cell count was normal in 21.6% in +ve and 11% of -ve group. CSF analysis revealed mild pleocytosis and protein elevation with low glucose. CD4 counts in seropositive patients (26-296; mean: 85) were significantly lower than seronegative patients (193-1540; mean: 603). Mortality in +ve group was 80% as compared to 55% in -ve group. Conclusion: Excruciating headache is the cardinal manifestation in patients with cryptococcal meningitis. Seizures, altered sensorium and low CD4 count were more common in seropositive patients while complications such as focal neurological deficits, cranial nerve palsies and hydrocephalus were more common in -ve patients. Mortality was significantly higher among +ve group. [ABSTRACT FROM AUTHOR]
- Published
- 2007