P248 Fungal meningitis in an immunocompetent individual

POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: OBJECTIVE: Fungal meningitis is commonly seen in individuals who are immunocompromised. It's a significant cause of morbidity and mortality in people living with HIV worldwide. Among HIV-infected patients of Manipur, it is the most common cause of meningitis and Cryptococcus neoformans is the only species identified so far both in HIV infected population and non-HIV patients in Manipur. The aim of this paper is to highlight the detection of C. gattii meningitis in the high HIV prevalence state of India. METHOD: A 53-year-old male, mechanic by profession residing in a village in Thoubal district of Manipur attended Medicine OPD with complaints of intractable headache, aggravated by sound and light, generalized weakness, hiccups, vomiting, and decreased appetite for 2 weeks. There was no history of altered sensorium. He is a known case of hypertension and was recently diagnosed with T2DM, not on medication. RESULTS: An MRI brain (Fig.1) showed a tiny sub-centric lesion in the bilateral centrum semiovale. Cerebrospinal fluid examination by India Ink preparation revealed capsulated budding yeast cells suggestive of Cryptococcus sps. Cryptococcal antigen testing (CryptoPS, Biosynex) was positive with a high titer. Culture on SDA and BSA showed growth of Cryptococcus sps. For phenotypic identification and antifungal susceptibility testing, the isolate was processed in VITEK 2(Biomerieux) system which identified it as C. gatti (94% probability). The isolate was sensitive to amphotericin B (mic: 0.5 μg/ml) and flucytosine (mic: 2 μg/ml). He tested negative for HIV on two occasions and his CD4 + count was 888 cell/mm3. Blood sugar was 225 mg/dl, with urine glucose leakage in traces. Blood and urine were collected for fungal culture which showed no growth. The patient was put on liposomal amphotericin B 200 mg daily. After 1 week, patient's condition was not deteriorating, although the improvement was minimal. The isolate was sent to the National Culture Collection of Pathogenic Fungi, PGIMER, Chandigarh, and it was confirmed as Cryptococcus gattii by MALDI-TOF assay. CONCLUSION: Detection of C. gattii in an immunocompetent patient in Manipur state, with a high prevalence of HIV is alarming because cryptococcal meningitis is the commonest form of meningitis in this population. In future, whenever Cryptococcus sps is isolated, it will be pertinent to keep in mind the possibility of other species of Cryptococcus to be the causative pathogen. We emphasize the importance and need for surveillance to detect its environmental niche.