Epidemiology and Antifungal Susceptibility of Cryptococcus neoformans in HIV-Positive Patients at University of Benin Teaching Hospital

Cryptococcal meningitis caused by Cryptococcus neoformans remains a leading cause of HIV-associated mortality in sub-Saharan Africa, yet its epidemiology and antifungal resistance profile in South South Nigerian clinical settings require empirical investigation. This study characterises the epidemiology and antifungal susceptibility of Cryptococcus neoformans in HIV-positive patients at the University of Benin Teaching Hospital (UBTH), Edo State. Cerebrospinal fluid and serum from 90 HIV-positive patients with suspected cryptococcal meningitis were screened by India ink preparation, cryptococcal antigen latex agglutination, and culture on Niger seed agar. Confirmed Cryptococcus neoformans isolates underwent minimum inhibitory concentration determination for fluconazole, amphotericin B, flucytosine, and voriconazole by broth microdilution. Molecular typing was performed using URA5-RFLP. Cryptococcal meningitis was confirmed in 36 percent of suspected cases. Cryptococcus neoformans var grubii (molecular type VNI) constituted 94 percent of isolates. Amphotericin B MICs were uniformly low (MIC90 0.5 mg/L), confirming its therapeutic utility. Fluconazole MIC90 was 8 mg/L, within susceptibility range. All isolates were susceptible to flucytosine. CD4 count below 100 cells/microliter was the strongest mortality predictor. The study provides antifungal susceptibility benchmarks for cryptococcal management at UBTH and recommends routine cryptococcal antigen screening in all HIV patients presenting with CD4 counts below 200. Keywords: Cryptococcus neoformans, cryptococcal meningitis, HIV, antifungal susceptibility, UBTH