Cryptococcal meningitis (C. neoformans var. gattii) leading to blindness in previously healthy melanesian adults in Papua New Guinea

Cryptococcal meningitis is a common cause of chronic meningitisin Papua New Guinea, affecting apparently immunocompetent people.The majority of infections are believed to be due to Cryptococcusneoformans var. gattii. We have reviewed the records of49 Melanesian adults who presented with proven cryptococcalmeningitis to the University teaching hospital in Port Moresby,and compare our findings with other published studies of cryptococcalmeningitis in the tropics and sub-tropics. None of the patientshad an obvious cause of immunosuppression. Visual disturbancesand fundoscopic changes of papilloedema or papillitis were particularlycommon. The in-hospital case fatality rate for patients treatedwith amphotericin B and flucytosine was 22.4%. Of the fullytreated patients, 31% became completely blind before being dischargedfrom hospital. Therapy directly aimed at reducing intracranialpressure may improve outcome.