Cryptococcal meningitis in human immunodeficiency virus (HIV)-positive and HIV-negative patients.

This study compared clinical manifestations, blood biochemistry and cerebrospinal fluid (CSF) results of HIV-positive and HIV-negative patients with cryptococcal meningitis. We collected 57 cases of cryptococcal meningitis from cytological specimens submitted to the Department of Tropical Pathology, Faculty of Tropical Medicine. Pertinent clinical data were analyzed retrospectively in 47 cases for clinical manifestations, laboratory features and outcomes of 38 HIV-positive and 9 HIV-negative patients. Headache was the most common symptom seen in all cases, of which 70.2% occurred with fever. CSF examination of both groups revealed elevated opening pressure. Increased CSF protein and depressed CSF glucose levels were seen in HIV-negative cases, which differed from HIV-positive cases, where a slight change was noted. CSF pleocytosis in HIV-positive patients was variable. Forty-eight percent of HIV-positive patients had CSF leukocyte counts below 20 cells/ mm3. None was found in the HIV-negative patients. Specific treatments with amphotericin B and fluconazole were given. Five fatal cases of cryptococcal meningitis were noted, all of which were HIV-positive. There were statistically significant differences in blood neutrophils, blood eosinophils, CSF leukocyte counts, CSF neutrophils, CSF lymphocytes, CSF glucose, and CSF total protein, in HIV-positive and HIV-negative patients (p = 0.050, p = 0.022, p = 0.002, p = 0.016, p = 0.047, p = 0.031, p = 0.009, respectively).

Cerebrospinal fluid analysis in eosinophilic meningoencephalitis.

Eosinophilic meningoencephalitis (EME) remains an important neurological disease and is widely distributed in Thailand. We analyzed the cytological specimens of 56 EME cases. Pertinent clinical data were analyzed retrospectively and correlated with the cerebrospinal fluid (CSF)analysis. Headache was the commonest symptom seen in all EME cases. History of raw or partially cooked Pila snail ingestion was elicited from most patients. There was a marked seasonal occurrence between July to January. Patients received specific treatment as supportive therapy, which included spinal taps, analgesics and corticosteroids, was adequate. No fatal cases were seen. The CSF specimens were sorted into two categories: fresh CSF and hematoxylin and eosin (H&E) stained centrifuged CSF sediment. There was a statistically significant difference between the number of eosinophils and lymphocytes of fresh CSF and the H&E stained centrifuged CSF sediment (p = 0.001 and 0.001 respectively). The CSF glucose and the number of eosinophils in both methods were significantly correlated (p = 0.000, p = 0.008 for fresh CSF and the H&E stained centrifuged CSF sediment respectively). Moreover, the number of eosinophils was statistically significant with the protein in the CSF (p = 0.013), and intracranial pressure (ICP) (p = 0.025). Higher yields of eosinophils, especially in the early course of the disease, can readily be detected in the H&E stained centrifuged CSF sediment, whereas fresh specimens were negative. Further tests may increase the sensitivity and specificity of EME diagnostic results.

Does HIV infection accelerate the development of hepatocellular carcinoma? A case report in a young man.

Hepatocellular carcinoma (HCC) is an important cancer. It occurs more often in men than women, and occurs mostly in people 50 to 60 years old. HCC has not been previously reported in a young HIV-seropositive patient in Thailand. We documented a very rare case of HCC in a 33 year old man. He was diagnosed and treated as Salmonella septicemia and tuberculosis. However, additional diagnosis based on pathological study disclosed a moderately differentiated HCC. Immunohistochemical study of the liver tissue was positive for hepatitis B surface antigen (HBsAg).