Cryptococcosis in India: the awakening of a giant?

The menace of cryptococcosis has assumed global proportions over the years. The tropical climate of the Indian subcontinent offers a suitable environm ent for Cryptococcus neoformans, and the onslaught of the acquired immune d eficiency syndrome (AIDS) pandemic since the early 1990s has substantially influenced the situation. Coupled with that are the advances in laboratory diagnostic techniques that have made accurate diagnosis increasingly availa ble. These factors together have led to a sharp increase in the number of r eported cases of cryptococcosis, This review attempts to present an overvie w of the status of cryptococcosis in India from its first description to th e most recent times. The disease has been reported from almost all parts of the country. C. neoformans var. neoformans is predominantly found in clini cal samples, while C. n. var. gattii infection has also been reported. An o rgan commonly involved is the central nervous system, among others. Both im munocompromised and apparently immunocompetent patients have been affected. Laboratory diagnosis is mostly by conventional methods, while effective th erapeutic options are limited. Early diagnosis followed by institution of s pecific therapy, where possible, has effectively reduced mortality. Awarene ss of the disease and maintenance of a high index of clinical suspicion is required. An integrated approach to patient management with active interact ion between the clinicians and the laboratory personnel would be highly ben eficial. The wide variety of presentations of the disease seen in India sug gests the possibility of occurrence of strain variation which needs to be i nvestigated fully. Introduction of routine testing of antifungal susceptibi lity of clinical isolates is also important in order to obtain baseline dat a on susceptibility patterns and to predict in advance any shift in those p atterns in the population. To maintain a high standard in all such endeavou rs, the establishment of an external quality control system is desirable.