Cryptococcal meningitis in immunocompetent Papua New Guinean children

We report three cases of meningo-encephalitis caused by Cryptococcous neoformans var. gattii in apparently immunocompetent children presenting to a provincial hospital in Papua New Guinea (PNG) over a nine-month period. After a postmortem diagnosis was made in the first case, a further two were iden...

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Bibliographic Details
Published in:Tropical doctor 2010-01, Vol.40 (1), p.61-63
Main Authors: Laman, M, Hwaihwanje, I, Davis, T M E, Manning, L
Format: Article
Language:English
Subjects:
Antifungal Agents - therapeutic use
Biological and medical sciences
Cerebrospinal Fluid - microbiology
Child
Cryptococcus neoformans - isolation & purification
Female
General aspects
Human mycoses
Humans
Immunocompetence
Infectious diseases
Male
Medical sciences
Meningitis, Cryptococcal - diagnosis
Meningitis, Cryptococcal - drug therapy
Meningitis, Cryptococcal - epidemiology
Meningitis, Cryptococcal - microbiology
Miscellaneous mycoses
Mycoses
Papua New Guinea - epidemiology
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Summary:We report three cases of meningo-encephalitis caused by Cryptococcous neoformans var. gattii in apparently immunocompetent children presenting to a provincial hospital in Papua New Guinea (PNG) over a nine-month period. After a postmortem diagnosis was made in the first case, a further two were identified quickly using Indian ink staining of cerebrospinal fluid (CSF). The second case had a complicated course and recovered after relapse. The third made a full recovery with appropriate antifungal therapy. Despite the fact that an environmental reservoir has not been established, cryptococcal meningo-encephalitis occurs regularly in PNG. In developing countries such as PNG, a lack of laboratory resources and limited therapeutic options can complicate the management of severe infections such as cryptococcosis. Nevertheless, with inexpensive diagnostic tests (such as Indian ink staining of CSF), a high index of suspicion and a pragmatic approach to antifungal therapy, good therapeutic outcomes can be achieved.
ISSN:0049-4755
1758-1133
DOI:10.1258/td.2009.090333