Cryptococcal Meningitis

McDonald, Robert; Greenberg, E. N.; Kramer, Rudolph

doi:10.1136/adc.45.241.417

Cited by 19 publications

(7 citation statements)

References 11 publications

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“…Cases have been reported with increasing frequency from Africa south of the Sahara-for example, West Africa,4 East Africa,5 Central Africa,67 and South Africa. 8 Cryptococcosis has also been reported in Zambia.F" More cases, both pulmonary and of the central nervous system, are being diagnosed because of awareness of the condition and better diagnostic facilities, but in some cases the diagnosis is established only at post-mortem. The disease is caused by a budding, yeast-like, non-mycelium-producing fungus Cryptococcus neoformans (Torula histolytica) which has a mucinous capsule and infects man and animals.…”

Section: Discussionmentioning

confidence: 96%

Pulmonary and bilateral retinochoroidal cryptococcosis.

Bisseru¹,

Bajaj²,

Carruthers³

et al. 1983

British Journal of Ophthalmology

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Section: Discussionmentioning

confidence: 96%

Pulmonary and bilateral retinochoroidal cryptococcosis.

Bisseru¹,

Bajaj²,

Carruthers³

et al. 1983

British Journal of Ophthalmology

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“…On India ink microscopy, it is detected by the nonstaining capsule around the organism. It can be mistaken for lymphocytes or other mononuclear cells if nonstaining capsule is not distinguished [ 7 ]. This is a simple and easily available test in resource-limited regions; unfortunately, its sensitivity is 42% when the CSF cryptococcus density is lower than 1000 CFU/mL [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…CSF centrifugation can possibly increase the sensitivity, but it is still lower than CrAg detection test [ 14 ]. CSF culture and growth of cryptococcus on Sabouraud medium can take days or weeks for the definitive results [ 7 , 14 ]. Although it is considered as the gold standard for the definite diagnosis, lack of availability of culture facility in resource-limited regions, longer time for incubation for diagnosis, and lower sensitivity are major disadvantages [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…These findings are not specific to CM. The diagnosis is generally based on the identification of cryptococci in India ink or growth of the fungus on culture [ 7 ]. These conventional methods have limited sensitivities for the diagnosis, and culture may take many weeks; therefore, cryptococcal antigen (CrAg) test should be performed at the early stage in every meningitis patient because the survival of the patients depends on the accurate and timely diagnosis of this fatal disease [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case of Cryptococcal Meningitis in a Child with a Congenital Heart Disease

Dhoubhadel

Laghu

Poudel

et al. 2021

Case Reports in Infectious Diseases

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Cryptococcal meningitis, which has a high mortality rate, is rare in immunocompetent children. Although many immunocompromised conditions are identified as predisposing factors, congenital heart disease in children is not well recognized as a predisposing factor for the disease. A 12-year-old female child presented with a progressively increasing headache for one month. There was history of vomiting and fever off and on. On examination, she had a pansystolic murmur and meningeal signs. Lumbar puncture was done; opening pressure was high (27 cm H2O) and white blood cell (WBC) count in cerebrospinal fluid (CSF) was slightly high. Gram staining, India ink preparation, and culture of CSF were negative. Cryptococcal antigen (CrAg) test was not available. Echocardiography showed a 12 mm ventricular septal defect (VSD). The patient was diagnosed as meningitis with VSD and treated with intravenous ceftriaxone and vancomycin; however, she did not improve after 7 days of antimicrobial treatment. She was then transferred to another hospital where India ink and culture of CSF showed cryptococcus; CrAg test was done, and it was positive. Despite the treatment with lyposomal amphotericin B and flucytosine, she died on 9th day of admission in pediatric intensive care unit. It is necessary for global advocacy for need of availability of CrAg test in resource-limited regions. Treating doctors should consider VSD, a congenital heart disease, as a predisposing factor for cryptococcal meningitis in children. As CrAg is more sensitive than India ink and culture, it should be the first line of investigation in suspected cases.

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“…Cryptococcal meningitis has been reported to be associated with steroid therapy (Wilson et al, 1970). Intravenous amphotericin B or oral 5-fiuorocytosine have proved effective treatment (Wilson et al, 1970;McDonald et al, 1970).…”

Section: Rare Meningitidesmentioning

confidence: 99%