[Cryptococcus neoformans meningoencephalitis in immunocompetent schoolchildren]

Area of Science:

• Pediatric Infectious Diseases
• Mycology
• Neurology

Background:

• Cryptococcus neoformans meningoencephalitis is a leading fungal infection of the central nervous system (CNS) in individuals with human immunodeficiency virus.
• It is uncommon in immunocompetent children and carries a high fatality rate, predominantly affecting males.

Observation:

• Two school children, a male and a female with pigeon exposure, presented with symptoms including fever, headache, photophobia, diplopia, ataxia, and meningeal signs, with unilateral cranial nerve VI involvement.
• Diagnosis was confirmed via Cryptococcus neoformans culture, India ink staining, and latex antigen agglutination in cerebrospinal fluid.
• Both patients had normal human immunodeficiency virus antibody tests and CD4/CD8/T lymphocyte counts.

Findings:

• The first patient developed a lung mass, a parietal lobe cryptococcoma, and intracranial hypertension, leading to an unfavorable outcome and death despite treatment with amphotericin B or fluconazole.
• The second patient experienced a favorable clinical evolution with the same treatments.

Implications:

• Cryptococcus neoformans infections in immunocompetent children are rare but serious, necessitating prompt diagnosis and effective treatment strategies.
• This case series highlights the variable outcomes and the importance of early intervention in pediatric cryptococcal meningoencephalitis.