Crypotococcal meningitis in a none-HIV infected five month old infant with rickets: Case report
Okwara, F. N.
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Crypotococcal is an invasive fungal disease, now endemic in the tropics. It is largely transmitted through inhalation, but can be transmitted locally through skin and eyes. Mostly, it causes disease in immune compromised individuals, especially older children and adults, where it causes disseminated disease. Baby JG aged 5 months presented with a prodrome of respiratory symptoms. His anterior fontanel was wide and bulging, and had poor muscle tone. A week later, he developed convulsions, and a depressed sensorium. Haemogram showed a leucocytosis. Bone metabolism showed serum low phosphate and high alkaline phosphatase. Cerebrospinal fluid biochemistry was unremarkable, but microscopy was positive for Indian ink stain and crypotococcal antigen. HIV PCR test was negative. Clinical improvement was observed on institution of anti meningitic therapy, and intravenous fluconazole, vitamin D3 and calcium supplementation, but another spike was noted on day 7 of therapy. The findings of crypotococcal meningitis in HIV seronegative infant is very rare. Immune reconstitution syndrome may occur during treatment. High index of suspicion for cryptococcosis is needed in high risk children with sub-acute presentations of meningitis, and a relatively normal CSF cell counts and biochemistry. Routine fungal screening of CSF for all suspected children is justified.