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Year : 2003  |  Volume : 21  |  Issue : 2  |  Page : 145
 

Cryptococcal meningitis in HIV negative infant


Department of Microbiology, JLN Medical College, Ajmer - 305 001, Rajasthan, India

Correspondence Address:
Department of Microbiology, JLN Medical College, Ajmer - 305 001, Rajasthan, India



How to cite this article:
Nirwan P S, Dalal A S, Peters B P, Rastogi V L, Mehta K. Cryptococcal meningitis in HIV negative infant. Indian J Med Microbiol 2003;21:145


How to cite this URL:
Nirwan P S, Dalal A S, Peters B P, Rastogi V L, Mehta K. Cryptococcal meningitis in HIV negative infant. Indian J Med Microbiol [serial online] 2003 [cited 2019 Aug 25];21:145. Available from: http://www.ijmm.org/text.asp?2003/21/2/145/8000


Dear Editor,
Cryptococcosis in an acute, subacute or chronic fungal infection caused by Cryptococcus neoformans.[1] Involvement of brain and meninges is the most common and life threatening clinical manifestation. The greatest risk is among the immunocompromised especially with HIV. The disease occurs in apparently healthy host also.[2] It is uncommon before puberty. We would like to share our experience - a case of cryptoccal meningitis in an HIV negative infant.
A three and half month old infant presented with fever, irritability and convulsions of three days duration with a similar past history at 1 month of age. Child was unimmunised, and negative for HIV. Mother was also negative for HIV and was from a rural background. On examination, weight and height were in the normal range and there was no finding which could suggest the immunocompromised status of the patient. Chest X-ray was normal, ultrasonography of brain revealed subdural effusion. CSF pressure was raised with cell count 300 cells/mm3 - 60% polymorphs, 40% lymphocytes, proteins - 90 mg/dL and sugar - 35.7 mg/dL. In direct wet mount of CSF spherical budding yeast cells of irregular size were seen, Gram staining revealed 4-14m in size spherical gram positive budding yeasts. India ink preparation showed characteristic predominant encapsulated budding yeasts. Culture on Sabouraud dextrose agar showed smooth creamy white mucoid colonies, the isolate was urease positive, grown at 37C and assimilated inositol. It was thus identified as Cryptococcus neoformans and confirmed by pigment production on niger seed agar at PGIMER Chandigarh.
The patient was treated with intravenous amphotericin and fluconazole. Primary cryptococcal meningitis is unusual in children especially in the absence of predisposing factors. Incidence in HIV infected pediatric patients is less than 1%[3] and unfortunately prospective data in HIV negative counterparts are lacking. Early diagnosis and treatment may lead to a better prognosis with lesser relapse rate in the unimmunocompromised hosts and is of most importance in pediatric age group as these patients may live longer. 

 ~ References Top

1.Rippon JW. Medical Mycology, the pathogenic fungi and the pathogenic actinomycetes, 3rd ed. (WB Saunders Co. Philadelphia) 1988:582-609.  Back to cited text no. 1    
2.Nelson, Text book of pediatrics, ((W.B. Saunders Co. Philadelphia), 15th ed. 1996:949-50.  Back to cited text no. 2    
3.Nicholas. HIV in childhood, adolescence and pregnancy, American Academy of Pediatrics, ELK grove village, IL-6009-0927(1989)83(2):293-307.  Back to cited text no. 3    
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2004 - Indian Journal of Medical Microbiology
Published by Wolters Kluwer - Medknow

Online since April 2001, new site since 1st August '04