Cryptococcal meningitis: Clinical, diagnostic and therapeutic overviews.

Cryptococcal meningitis has emerged as a leading cause of infectious morbidity and mortality in patients with AIDS. Among the human immunodeficiency virus (HIV)-seropositive subjects, cryptococcal meningitis is the second most common cause of opportunistic neuro-infection. Current trends are changing due to the marked improvement of quality and length of life produced by highly active antiretroviral therapy (HAART). The introduction of generic HAART in India has resulted in an increase in the number of individuals getting treatment for HIV infection, as the cost of highly active antiretroviral therapy (HAART) has decreased 20- fold. Cryptococcal meningitis occurs in non-HIV patients who are immunodeficient due to diabetes, cancer, solid organ transplants, chemotherapeutic drugs, hematological malignancies etc and rarely in healthy individuals with no obvious predisposing factors. Diagnosis of cryptococcal meningitis is fairly straightforward once the diagnosis is considered in the differential diagnosis of chronic meningitis. Treatment of a patient with cryptococcal infection is a challenge for both the physician and the patient, but rewarding, as many would recover with timely and adequate antifungal therapy.

Neuroleptospirosis - revisited: experience from a tertiary care neurological centre from south India.

BACKGROUND & OBJECTIVES: Leptospirosis is a zoonotic disease commonly reported from south India. Neurological manifestations seen in about 10-15 per cent of cases, are protean and remain unrecognized and diverse. We evaluated the pattern of nervous system involvement in leptospirosis, among patients presenting to the emergency services of a tertiary care neurological centre in south India, and also analysed the outcome and prognostic indicators. METHODS: The diagnosis of neuroleptospirosis was based on clinical and laboratory evidence of hepatorenal syndrome, and serum or CSF positivity for antileptospira antibody by a macroscopic agglutination test (MAT) and by ELISA in a limited number of samples. RESULTS: A total of 31 patients (M:F 27:4, age range 6-68 yr, mean 36.4 +/- 14.3 yr) were treated during the five year period. Acute fever with chills and rigors, headache and vomiting were the presenting manifestations; 25 patients (81%) had altered sensorium for a period ranging from 1- 8 days, four (12.9%) being deeply comatose. Eleven (35.5%) had acute symptomatic seizures at the time of presentation. Conjunctival congestion with or without haemorrhage was seen in 12 patients (38.7%), icterus in 14 (45%) and mild hepatosplenomegaly in 11 (35.5%). Early papilloedema was observed in three. Only three patients had localizing deficits. CT scan was normal in 18 of 27 (67%), while 7 (26%) had diffuse cerebral oedema. CSF pleocytosis with lymphocytic predominance (mean 50 cells/microl) and elevated protein levels (mean 115.5 +/- 67.5 mg %) were noted. Leptospira antibody was detected in serum of all, and 5 of 22 in CSF samples. Eight patients (26%) succumbed. Deep altered sensorium at presentation and raised CSF protein were two poor prognostic indicators. Pathological study of brain in five cases revealed encephalitic features and in addition immune mediated acute disseminated encephalomyelitis (ADEM) like pathology in two cases. INTERPRETATION & CONCLUSION: Neuroleptospirosis should be considered in the differential diagnosis of neuroinfections associated with hepatorenal dysfunction, in endemic areas. Leptospira antibody can be detected in CSF also in some cases. Deep altered sensorium at presentation indicates poor prognosis.

Tuberculous skin ulcer following needle-prick injury in a health care professional.

A case of cutaneous inoculation tuberculosis in a 25-year old health care professional is reported. The diagnosis was confirmed by histopathology and isolation of Mycobacterium tuberculosis by BACTEC 460TB radiometric method. Rapid healing of the ulcer was noted in response to surgical debridement and specific anti-tuberculous therapy.

Diagnosis of neurotoxoplasmosis by antibody detection in cerebrospinal (CSF) fluid using Latex Agglutination Test and ELISA.

The present study was carried out to evaluate the utility of Anti-Toxoplasma gondii antibody detection in CSF specimens using Latex Agglutination Test (LAT) and Enzyme Linked Immunosorbent Assay (ELISA) for the diagnosis of NT. The study included CSF specimens from twenty-five HIV seropositive, autopsy proven (histopathological) cases of NT and 29 control cases with CNS diseases other than NT. All the specimens were subjected for antibody detection by LAT, IgG ELISA and IgM ELISA. Out of 25 CSF samples from autopsy proven cases of NT, LAT was positive in 48%, whereas ELISA for IgG antibody was positive in 92% of the cases. IgM antibodies were present in only one case that was also positive by LAT and IgG ELISA. None of the control CSF specimens showed anti-T. gondii antibodies either by LAT or ELISA. Detection of anti-T. gondii IgG antibodies in CSF can be a useful adjunct to the clinical and CT findings in the diagnosis of NT. IgG ELISA is more sensitive when compared to LAT. IgM antibody detection has a negligible value in the diagnosis of NT.