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 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.
Laman
M
M
School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, Western Australia, Australia. larmens@xtra.co.nz
Hwaihwanje
I
I
Davis
T M E
TM
Manning
L
L
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
D000935:Antifungal Agents