Cryptococcal meningitis in immunocompetent patients

Five cases of cryptococcal meningitis (CM) in immunocompetent patients who were initially diagnosed as either tuberculous meningitis or partially treated pyogenic meningitis are presented. There were 3 male and 2 female patients in the age range of 21 to 42 years. These patients presented as subacute meningitis. Additional features were visual impairment (4 cases), papilloedema (3 cases), sixth cranial nerve palsy (3 cases) and ataxic hemiparesis (one case). There was a mediastinal mass of fungal aetiology in one patient. While routine analysis of CSF showed a variable picture, it is the India ink preparation, test for cryptococcal antigen and culture for fungus which gave the diagnosis. These patients were treated with standard antifungal therapy. While one patient died and one patient recovered completely, three other patients were left with permanent visual impairment. It is concluded that CM is uncommon but an important cause of non-acute meningitis and should be included in the list of causes of preventable blindness.