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Visual loss in immunocompetent patients with Cryptococcus neoformans var. gattii meningitis

R A Seaton1, N Verma, S Naraqi

  • 1Department of Clinical Science, Medical Faculty, University of Papua New Guinea, Boroko, New Guinea.

Transactions of the Royal Society of Tropical Medicine and Hygiene
|January 1, 1997
PubMed

Insights

Cryptococcal meningitis in Papua New Guinea, primarily caused by Cryptococcus neoformans var. gattii in immunocompetent individuals, frequently leads to vision loss. Early signs like abducens palsy predict poor visual outcomes.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Neurology

Background:

  • Cryptococcal meningitis is prevalent in Papua New Guinea, predominantly affecting immunocompetent individuals.
  • Cryptococcus neoformans var. gattii is responsible for 95% of cases in this population.
  • Ocular complications are a frequent occurrence in these patients.

Purpose of the Study:

  • To review ophthalmic findings in 82 immunocompetent patients with cryptococcal meningitis.
  • To identify clinical features that predict unfavorable visual outcomes.

Main Methods:

  • Retrospective review of ophthalmic findings in immunocompetent patients.
  • Analysis of factors associated with visual loss and optic atrophy.
  • Correlation of cerebrospinal fluid (CSF) cryptococcal antigen titers and intracranial pressure with visual outcomes.

Main Results:

  • Visual loss occurred in 52.6% of survivors, with optic atrophy following optic disc swelling in 60.9%.
  • Abducens palsy and CSF cryptococcal antigen titers > 1:1024 predicted progression to optic atrophy.
  • Raised intracranial pressure was not associated with visual loss.

Conclusions:

  • The high rate of visual loss in immunocompetent patients with C. neoformans var. gattii meningitis contrasts with outcomes in immunosuppressed patients.
  • Immune-mediated optic nerve dysfunction is a potential mechanism for visual loss.
  • Early identification of predictive factors is crucial for managing ocular complications.

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