Cryptococcal meningitis in immunocompetent Papua New Guinean children

• Published in: Tropical doctor Vol. 40; no. 1; p. 61
• Main Authors: Laman, M, Hwaihwanje, I, Davis, T M E, Manning, L
• Format: Journal Article
• Language: English
• Published: England 01-01-2010
• Subjects: Antifungal Agents - therapeutic use; Cerebrospinal Fluid - microbiology; Child; Cryptococcus neoformans - isolation & purification; Female; Humans; Immunocompetence; Male; Meningitis, Cryptococcal - diagnosis; Meningitis, Cryptococcal - drug therapy; Meningitis, Cryptococcal - epidemiology; Meningitis, Cryptococcal - microbiology; Papua New Guinea - epidemiology; Papua New Guinea
• ISSN: 1758-1133
• DOI: 10.1258/td.2009.090333

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.