Cryptococcal meningitis in children in Papua New Guinea: a reminder

Two young males from Central Province were referred to Port Moresby General Hospital with chronic headaches. In each case the initial impression of tuberculous meningitis needed revision in the light of strongly positive cryptococcal serology. Cryptococcal meningitis occurs with sufficient frequency in Papua New Guinea that it should be considered in cases of raised intracranial pressure, ataxia, cranial neuropathy and visual disturbances. Delay in treatment may be disastrous. In contrast to the developed world where fungal meningitides show a predilection for the immunosuppressed, the experience to date in Papua New Guinea is that the majority of cases in both adults and children occur in ostensibly immunocompetent individuals. The epidemiology, clinical course and current treatment of this potentially curable disease are discussed.