Title : Cryptococcal meningitis in an HIV-negative apparently immunocompetent adult with occupational poultry exposure: A case report
Abstract:
Background: Cryptococcal meningitis is a severe invasive fungal infection of the central nervous system that is typically associated with advanced HIV infection and other forms of impaired cell-mediated immunity. Its occurrence in immunocompetent individuals is uncommon and often poses a diagnostic challenge because of its insidious onset and nonspecific clinical manifestations. We describe a case of cryptococcal meningitis in an HIV-negative, apparently immunocompetent adult to highlight the importance of maintaining a high index of suspicion in patients presenting with chronic meningitis.
Case Description: A 42-year-old Filipino fisherman with no known immunocompromising condition presented with a six-week history of progressively worsening headache accompanied by intermittent fever, malaise, blurred vision, disorientation, and neck stiffness. He had sought medical attention at several healthcare facilities before referral because of persistent symptoms. Cranial computed tomography demonstrated ventriculomegaly without focal intracranial lesions. Cerebrospinal fluid analysis showed mononuclear pleocytosis, while India ink microscopy revealed encapsulated yeast forms consistent with Cryptococcus spp., subsequently confirmed by multiplex polymerase chain reaction. HIV serology was nonreactive. Because Flucytosine was unavailable, induction therapy consisted of Amphotericin B lipid complex plus Fluconazole for two weeks, followed by Fluconazole consolidation and maintenance therapy. The patient demonstrated progressive neurological recovery, with repeat cerebrospinal fluid examination confirming microbiological clearance.
Discussion: This case underscores that cryptococcal meningitis should not be excluded solely on the basis of an apparently intact immune status. In patients with subacute or chronic meningitis, delayed recognition can occur when the diagnosis is not initially considered. Comprehensive clinical assessment, including occupational and environmental exposure history, together with early cerebrospinal fluid examination using both conventional and molecular diagnostic techniques, is critical for timely diagnosis. Furthermore, this case demonstrates that favorable clinical and microbiological outcomes can be achieved with Amphotericin B plus Fluconazole when Flucytosine is not available, a scenario frequently encountered in resource-limited settings.
