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Cryptococcal meningitis in immunocompetent patients
1Department of Medicine, Armed Forces Medical College, Pune.
Abstract:
Five cases of cryptococcal meningitis (CM) in immunocompetent patients who were initially diagnosed as either tuberculous meningitis or partially treated pyogenic meningitis are presented. There were 3 male and 2 female patients in the age range of 21 to 42 years. These patients presented as subacute meningitis. Additional features were visual impairment (4 cases), papilloedema (3 cases), sixth cranial nerve palsy (3 cases) and ataxic hemiparesis (one case). There was a mediastinal mass of fungal aetiology in one patient. While routine analysis of CSF showed a variable picture, it is the India ink preparation, test for cryptococcal antigen and culture for fungus which gave the diagnosis. These patients were treated with standard antifungal therapy. While one patient died and one patient recovered completely, three other patients were left with permanent visual impairment. It is concluded that CM is uncommon but an important cause of non-acute meningitis and should be included in the list of causes of preventable blindness.
Insights
Cryptococcal meningitis (CM) is an uncommon cause of non-acute meningitis in immunocompetent individuals. Early diagnosis using India ink, cryptococcal antigen tests, and fungal cultures is crucial for effective treatment and preventing blindness.
Area of Science:
- Neurology
- Infectious Diseases
- Mycology
Background:
- Cryptococcal meningitis (CM) can mimic other forms of meningitis, leading to delayed diagnosis.
- Immunocompetent individuals can develop CM, presenting a diagnostic challenge.
Purpose of the Study:
- To present cases of cryptococcal meningitis in immunocompetent patients initially misdiagnosed.
- To highlight diagnostic methods and clinical outcomes for CM in this population.
Main Methods:
- Case series analysis of five immunocompetent patients with cryptococcal meningitis.
- Review of clinical presentations, diagnostic workup (CSF analysis, India ink, cryptococcal antigen, fungal culture), and treatment outcomes.
Main Results:
- Subacute meningitis presentation with neurological deficits including visual impairment and cranial nerve palsies.
- Diagnosis confirmed by India ink preparation, cryptococcal antigen testing, and fungal culture.
- Variable outcomes with one death, one complete recovery, and three cases of permanent visual impairment.
Conclusions:
- Cryptococcal meningitis is an important, though uncommon, cause of non-acute meningitis in immunocompetent hosts.
- Timely diagnosis through specific fungal tests is vital.
- CM should be considered in the differential diagnosis of meningitis to prevent potentially avoidable blindness.