meningitis

A 30yr male referred to me from a hospital with complaints of alternated sensorium/ delerium since 5 days with Hiv +ve status and csf reports attached Kernig sign positive Kindly give your opinion on the same for treatment option

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CSF shows lymphocytic pleocytosis.CSF protein sugar other parameters are not available. In view of the alteration in sensorium / deleroum the possibility is HIV ENCEPHALITIS. Is a serious complication of HIV. You have to exclude cryptococcus,cytomegalovirus,Toxoplasmosis etc. NeedsCD4 count with viral load. MRI brain ANTI RETROVIRAL THERAPY, Symptomatic med for higher function changes

Thanks for replying ma'am No history of retroviral therapy (recently diagnosed) MRI done - WNL Cd4 count reports awaited I am suspecting cryptococcal meningitis and planning to start amphotercin B and flucystosine
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In view of very high prevalence of Tuberculosis in india you have to exclude it for any chronic meningitis High cells with lymphocytes prevalence doesnt suggest any diagnosis What about protein, sugar, corresponding blood sugar, gram and afb stain ? Nonspecific fungus like structure doesn't give any lead for diagnosis..!! Even in HIV encephalopathy there is high cells with leucocyte may be there and that fungus like structure may be contamination.. If doubts of cryptococcus go for india ink and/or cryptococcus antigen Some time dual infection (tb with cryptococcus) can be there with hiv

Low glucose.. high protein.. lymphocytic pleocytosis.. yeasts + .. It's most likely fungal meningitis..

Thank you doctor
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