A study of cerebrospinal fluid analysis in HIV positive individuals

Dr.Heena Maulek Desai; Dr.Asha Sharad Shenoy; Dr.Aparna Mandvekar

Volume : V, Issue : IV, April - 2016

A study of cerebrospinal fluid analysis in HIV positive individuals

Dr. Heena Maulek Desai, Dr. Asha Sharad Shenoy, Dr. Aparna Mandvekar

Abstract :

 Background: Classical clinical features and laboratory diagnosis are rarely seen in HIV positive patients due to the effect of suppressed immunity and unusual organisms involved. This study aims to emphasize the importance of a timely CSF examination in HIV patients suspected to have CNS disease and correlating it with clinical and radiologic findings which will further help in the management of the disease. Materials & methods: The present study was a prospective analysis carried out over a period of 2 years where CSF samples from diagnosed HIV positive patients with clinically suspected diseases of the CNS were studied. The CSF samples were analyzed for pathological (Gross examination, Protein, sugar, microscopic examination, ADA levels) and microbiological parameters (special stains and culture). Results: Out of 215 CSF samples received over a period of 2 years, 90 cases were diagnosed as meningitis on CSF examination. Amongst these, 26 cases (28.88%) were found to be HIV positive. All HIV positive cases had meningitis. Of these 15 (57.7%) were cases of TBM and 11 (42.3%) were cases of Cryptococcal meningitis. Maximum cases were males with a male: female ratio of 3:2. In cryptococcal meningitis, the total protein varied from 53 mg/dL to 174.1mg/dL with a mean value of 88.57 mg/dL, which was lower than that seen in TBM (mean value 185.4mg/dL). The glucose level varied from 12.6 mg/dL to 62.4 mg/dL with a mean level of 38.75 mg/dL as compared to TBM with a mean value of 34mg/dL. The cases of TBM had a CD4 cell count between 54-640 cells/µL whereas the cases of cryptococcal meningitis had lower CD4 counts ie. 12-98 cells / µL. Death was the final outcome in 8 cases of TBM while only 2 cases of cryptococcal meningitis expired and 9 cases were discharged without any neurodeficit. Conclusion: For proper evaluation of CSF in HIV patients, one should have adequate knowledge about the tests to be performed in various CNS diseases, normal ranges with respect to the patient’s age and the test’s limitations. Also in some cases where clinical signs and symptoms may be subtle and radiology may not show significant abnormalities, the diagnosis rests solely on the identification of the etiologic agent in the CSF.