DIFFERENCES IN TUBERCULAR AND CRYPTOCOCCAL MENINGITIS AS INITIAL MANIFESTATION OF AIDS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 68
Abstract
BACKGROUND Tuberculous meningitis (TBM) and cryptococcal meningitis (CCM) are among the most common CNS opportunistic infections in patients with HIV/AIDS and have a high mortality. They can be the initial manifestation of HIV infection. CCM and TBM present with a near similar clinical picture. Differentiation between these two is difficult on clinical ground. Also, basic cerebrospinal fluid (CSF) characteristics are frequently indistinguishable. The present study was designed to observe the differences in clinical presentation and outcomes between CCM and TBM in newly diagnosed HIV patients. MATERIALS AND METHODS This study was a descriptive study. Patients presenting with chronic meningitis, who tested positive for HIV were included in the study. Their detailed history, physical examination, CD4 count, cerebrospinal fluid examination including India Ink preparation and Cryptococcal antigen test (CRAg) were done. CRAg was done in CSF by Cryptococcal Antigen Latex Agglutination System. Patients were treated as per standard protocols and outcome was assessed at four months. The collected data was analysed by descriptive statistical methods. RESULTS A total of 94 patients were studied. Out of all 45.74% cases were of TBM, 36.17% of CCM and 18.0% of other OI. Male to female ratio in CCM was 6: 1 and in TBM was 5.7: 1. Mean age and CD4 count of CCM patients were 37 ± 10.74, 81 ± 28.42 and of TBM were 38 ± 7.80, 84 ± 47.1. Headache was more prevalent in CCM patients (98%) than TBM (79%). CSF was near normal in CCM patients. In comparison to TBM (43.3%), mortality was higher in CCM group (56.0%) at four months followup. Low CD4 count was associated with poor prognosis. CONCLUSION Meningoencephalitis is not an uncommon initial presentation in HIV/AIDS patients. TBM and CCM are the most common causes. Both have common clinical presentation, but CSF findings in CCM patients are near normal in comparison to TBM. Prognosis of both the diseases is poor in spite of full treatment, but worst in CCM.
Authors and Affiliations
Mahim Mittal, Sudheer Yadav, Azhar Ali Khan
Keywords
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- EP ID EP232618
- DOI 10.14260/Jemds/2017/1055
- Views 83
- Downloads 0
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