Incidence and Antifungal Resistance of Cryptococcus neoformans in HIV-Positive Patients at LUTH, Lagos State

Cryptococcal meningitis caused by Cryptococcus neoformans remains a leading opportunistic infection in HIV-positive individuals with advanced immunosuppression, carrying high case fatality rates in sub-Saharan Africa. This study investigated the incidence and antifungal resistance profiles of C. neoformans in HIV-positive patients at Lagos University Teaching Hospital (LUTH), Lagos State, South West Nigeria. Cerebrospinal fluid (CSF) and blood samples from 120 HIV-positive patients presenting with meningitic symptoms were processed by India ink preparation, latex agglutination for cryptococcal antigen, and culture on Birdseed agar. Confirmed isolates were subjected to antifungal susceptibility testing by the EUCAST broth microdilution method for fluconazole, amphotericin B, flucytosine, and voriconazole. Results showed a C. neoformans incidence of 22.5 percent among symptomatic HIV-positive patients, predominantly those with CD4 counts below 100 cells/mm³. Fluconazole MIC values indicative of reduced susceptibility were detected in 18.5 percent of isolates, while no amphotericin B resistance was recorded. Flucytosine retained good activity (MIC90: 1 mg/L). Prior fluconazole prophylaxis was the most significant predictor of reduced fluconazole susceptibility. These findings confirm that cryptococcal meningitis remains a critical opportunistic infection burden at LUTH and highlight the clinical implications of fluconazole prophylaxis on treatment susceptibility, calling for routine MIC testing before therapy selection. Keywords: Cryptococcus neoformans, HIV, cryptococcal meningitis, antifungal resistance, LUTH.