The Cryptococcus neoformans Challenge in Immunocompromised Patients: A Two Year Case Series from Western Rajasthan with Review of Literature

Cryptococcosis is a severe opportunistic fungal infection caused by Cryptococcus neoformans or Cryptococcus gattii (critical fungal pathogens), primarily affecting immunocompromised individuals such as those with Human Immunodeficiency Virus (HIV), postorgan transplant patients, or those on prolonged immunosuppressive therapy. Tuberculosis (TB) and cryptococcal meningitis are leading causes of morbidity and mortality in advanced HIV disease. This case series highlights five patients with varied clinical presentations, including postrenal transplant complications, co-infection with TB and disseminated disease in HIV-positive individuals. Diagnosis relied on cerebrospinal fluid analysis, cryptococcal antigen testing and advanced imaging techniques. Treatment included liposomal amphotericin-B, fluconazole and supportive therapies. Despite aggressive management, outcomes varied, with some patients surviving while others succumbed to the infection. The series underscores the challenges in diagnosing and managing cryptococcosis, particularly in resource-limited settings, as well as the increased mortality associated with co-infection, which is a public health concern. Therefore, authors emphasise the need for improved diagnostic tools and integrated management strategies for better patient outcomes. With the rise in case studies of cryptococcosis, there is an increase in awareness; however, to control this menace, a high level of alertness and surveillance must be maintained at both clinical and laboratory levels. Only then can this “awakening giant” be contained.