Emerging Cryptococcosis cases in Himalayan & Sub-Himalayan regions of India

BackgroundCryptococcosis is a life-threatening opportunistic fungal infection, predominantly affecting immunocompromised individuals such as people living with HIV (PLHIV), but increasingly recognized among non-HIV patients with chronic comorbidities. Despite being a major contributor to meningitis-related mortality, there is limited regional data from North India, especially the Himalayan belt. AimTo describe the clinical, laboratory, and epidemiological profile of microbiologically confirmed cryptococcosis in a tertiary care center in Northern India and identify predictors of morbidity and mortality. MethodsA retrospective observational study was conducted at AIIMS Rishikesh from January 2018 to December 2024. Adult patients (>15 years) with confirmed cryptococcosis were included. Data were extracted using structured REDCap forms and analyzed for demographics, risk factors, clinical presentation, treatment, and outcomes. Subgroup analyses and logistic regression were performed. ResultsAmong 33 cases, 66.7% were HIV-positive. Fever (90.9%), headache (78.8%), and altered sensorium (54.5%) were the most common symptoms. Amphotericin B was used in 90.9% of patients, while flucytosine and fluconazole were administered in 45.5% and 66.7%, respectively. In-hospital mortality was 21.2%; however, with the inclusion of 1-year follow- up, mortality went up to 51.5%. Uncontrolled diabetes mellitus was significantly associated with mortality (p=0.019). Amphotericin B use was significantly lower among Himalayan patients (p=0.030), correlating with a trend toward higher mortality. ConclusionCryptococcosis is associated with high morbidity and mortality in both HIV and non-HIV patients. Prompt diagnosis and equitable antifungal access, especially in Himalayan regions, are critical to improving outcomes.