Cryptococcal Meningitis (CM) is a central nervous
system infection caused by a fungus. A large majority of cases are caused by
Cryptococcus neoformans var. neoformans. The fungus C. neoformans is found in
soil that contains bird droppings, particularly pigeon excreta, all over the
world. Cryptococcusneoformans var. gatti, on the other hand, is found primarily
in tropical and subtropical regions trees, most commonly eucalyptus trees. It
grows in the debris around the trees’ bases. Cryptococcal meningitis usually
occurs in people who have a compromised immune system and is a rare occurrence
in someone who has a normal immune system. Of the two fungi, Cryptococcalgattii
is the one more likely to infect someone with a normal immune system.The
incidence of infections caused by C.neoformans has risen markedly over the past
20 years as a result of the HIV/AIDS epidemic and increasing use of
immunosuppressive therapies. Cryptococcal meningitis is a common opportunistic
infection and an AIDS-defining illness in patients with late-stage HIV
infection, particularly in Southeast Asia and Southern and East Africa. It is
widely considered as the most common life-threatening AIDS related fungal
infection. Cryptococcal meningitis has been estimated at about 70 to 90%
worldwide in AIDS patients with mortalities of between 50% to 70% in
Sub-Saharan Africa. [2,3,4] Mortality from HIV-associated cryptococcal
meningitis remains high (13–33%), even in developed countries, because of the
inadequacy of current antifungal drugs and combinations, and the complication
of raised intracranial pressure.[2,7,8]In the cases presented, the findings
were so non-specific that the diagnosis was highly dependent on the CSF findings.
Based on the characteristics of the presenting signs and symptoms, Cryptococcal
meningitis should always be included in the differential diagnosis of chronic
or subacute meningoencephalitis, since clinical features are not specific.
Zambia Demographic Health Survey
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Disease Control and Prevention: C. gattii Infection Statistics (http://www.cdc.gov/fungal/diseases/cryptococcosis-gattii/statistics.html),
last updated May 2015.
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Berger (2015).Cryptococcosis: Global Status, By GIDEON Informatics, Inc.,
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Gray K, Watrea C et al. (2002) Cryptococcal infection in a cohort of
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[10.] John W
King, MD( 2014).Cryptococcosis
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Masur H, Holmes KK, USPHS, Infectious Diseases Society of America (2002)
Guidelines for Preventing Opportunistic Infections Among HIV-Infected Persons
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Fisher D, Naraqi S, Laurenson I, Temu P, Sinha A, et al. Cryptococcal
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healthy Melanesian adults in Papua New Guinea. The Quarterly journal of
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[13.] Mwaba P.
Mwansa J, Chintu C et al. (2001) Clinical presentation, natural history, and
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ST, Quan VC, Cohen C, Dawood H, Karstaedt AS, McCarthy KM, Whitelaw AC,
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in South Africa (GERMS-SA) AIDS. 2012 Nov 28; 26(18):2307-14. [PubMed] A
comparison of cases of paediatric-onset and adult-onset cryptococcosis detected
through population-based surveillance, 2005-2007.
PA, Bauer M, Leal ME et al. (1999) Early mycological treatment failure in
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Naraqi S, Wembri JP, Warrell DA (1996) Predictors of outcome in Cryptococcus
neoformans var. gattii meningitis. Q J Med, 89, 423–8.
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Long, Larry K. Pickering, Charles G. Prober: Principles and Practice of
Pediatric Infectious Diseases, 2012 (https://books.google.co.zm/books?isbn=1455739855)
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Dlamini S, Paul N, Dedicoat M. Treatment of acute cryptococcal meningitis in
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Hasbun R, Jekel J, Quagliarello VJ (2002). "The diagnostic accuracy of
Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected
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