Clinical pattern and antifungal susceptibility of cryptococcus neoformans from cryptococcal meningitis patients in northern india

Author: 
Pushpa Yadav, Manodeep Sen, Anupam Das, Janmejai Kumar Srivastava, Ajai Kumar Singh, Pradeep Kumar Maurya, Poonam Chaturvedi, Hardeep Singh Malhotra, Gaurav Raj Agrawal and Tanushri Chaterji

Background:- Cryptococcal meningitis (CM) is recognized as a disease of the immunocompromised or HIV patients. Early diagnosis and treatment is the key to reducing morbidity and mortality associated with CM.
Method: - CSF from all cases of Cryptococcal meningitis were tested for positive India ink, Cryptococcal Antigen Latex Agglutination test, followed by fungal culture and Urease Biochemical test. For Pathological examination, CSF cell count, Biochemical Analysis and corresponding blood sugar level were recorded.
These isolates were further subjected to an automated yeast identification and susceptibility system- VITEK 2-Compact TM (Biomerieux, India) and observe antifungal sensitivity pattern for Amphotericin B, Fluconazole and Voriconazole based on Clinical and Laboratory Standards Institute (CLSI) guidelines.
Result: - In two years of study, there were 31 cases of Cryptococcal meningitis including 10 cases with HIV co-infection. The most common (in all 31 patients) complaint was fever and headache. In all, 31 cases India ink and CALAS test results were positive in 100%, but 58.06% (18/31) were culture positive. Out of 31, 18 isolates were culture positive for Cryptococcus neoformans; which were 100% sensitive to Amphotericin B and Fluconazole. 38.8% (7/18) were resistant to Voriconazole.
Conclusion: - In present study, headache and fever were the commonest manifestation. Antifungal testing is more helpful to document the emergence of resistance.

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DOI: 
http://dx.doi.org/10.24327/ijcar.2019.19588.3788
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