title: Cryptococcal meningitis in immunocompetent Papua New Guinean children.
abstract: 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.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, Western Australia, Australia. larmens@xtra.co.nz
authors.forename: M
authors.initials: M
authors.lastname: Laman
authors.forename: I
authors.initials: I
authors.lastname: Hwaihwanje
authors.forename: T M E
authors.initials: TM
authors.lastname: Davis
authors.forename: L
authors.initials: L
authors.lastname: Manning
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D007121:Immunocompetence; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D010219:Papua New Guinea / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents