Management of AIDS Related Cryptococcus Neoformans Meningitis in a Rural Hospital Setting

Abstract

Background: Cryptococcal meningitis is an opportunistic infection caused by Cryptococcus neoformans or Cryptococcus gattii. Case Presentation: This case describes a 34 year-old Indonesian female who presented with fever associated with vomiting, headache, photophobia and neck stiffness. On physical examination she had high grade pyrexia with obvious signs of meningism. Lumbar puncture revealed intracranial hypertension of 90cmH2O. Cerebrospinal fluid (CSF) analysis detected the presence of cryptococcal antigen which was later confirmed as Cryptococcus neoformans on species identification testing using polymerase chain reaction (PCR) method. India Ink tested positive. The CECT and MRI of the brain were normal. Her HIV ELISA analysis was reactive with a low CD4 count of 38cells/mm3. The HIV viral load was 500,000 copies/ ml. She was treated with intravenous Amphotericin B and oral flucytosine for 4 weeks. She underwent repeated lumbar punctures until her CSF pressure normalized. Repeated CSF analysis post treatment showed complete clearance of Cryptococcus neoformans. Conclusion: Its effective management of Cryptococcus neoformans meningitis relies on quick identification of the organism, relief of intracranial pressure and commencement of antibiotic treatment.