Cryptococcal Meningitis: Looking beyond HIV

Introduction: Cryptococcal meningitis is a type of meningitis. It has conventionally associated with HIV infection. However, few cases are also described in patients with other forms of immunosuppression and in apparently immunocompetent individuals as well. Objectives: We reviewed 15 cases hospitalized and diagnosed with cryptococcal meningitis at Kasturba Hospital, Manipal in the last two years. We also compared the clinicopathologic characteristics of meningitis in HIV positive and HIV negative groups. Results: 9 of 15 patients with cryptococcal meningitis had been diagnosed with HIV, remaining 6 were HIV negative. The predominant clinical features in both groups were headache, vomiting and fever. The patients with HIV had the following features: more acute onset of signs and symptoms a higher mortality rate, low to normal leucocyte count with a predominance of neutrophils and an initial high cryptococcal antigen titre. The CSF glucose was low whereas the protein was elevated. The HIV negative group had a late onset of illness, higher leucocyte count with a predominance of lymphocytes and lower cryptococcal antigen titre. The CSF glucose and protein were normal. Conclusion: Both groups had a well-defined set of characteristics which could be useful in diagnosing and predicting the course of the disease.