MENINGITIS CAUSED BY CRYPTOCOCCUS-NEOFORMANS VAR GATTII AND VAR NEOFORMANS IN PAPUA-NEW-GUINEA

Eleven cases of cryptococcal meningitis were diagnosed and biotyped fr om September 1991 to August 1992 in Papua New Guinea (PNG). Seven isol ates were Cryptococcus neoformans var. gattii from paediatric and adul t patients, one with diabetes mellitus and 4 were C. neoformans var. n eoformans from adults, of whom 2 had human immunodeficiency virus type 1 (HIV-1) infection, and one each had tuberculosis and Plasmodium viv ax malaria. Significant clinical findings were headache, fever, mening ism, vomiting, photophobia, papilloedema and cranial nerve lesions. Fi ve patients (45.5%) died; 3 of these were adults with var. gattii and 2 were men with both var. neoformans and HIV-1 infections. This prospe ctive tropical study documents the emergence of C. neoformans var. neo formans in patients with HIV-1 infection in a country where previously var. gattii had predominated in the immunocompetent. There has been n o earlier report of cryptococcosis in an HIV-1 seropositive patient in PNG. Despite presumed exposure to both varieties of C. neoformans, va r. gattii infections had been most frequent. As HIV-1 spreads, the pro portion of hosts infected with var. neoformans may rise. The course of meningitis caused by the 2 varieties of C. neoformans may differ, wit h mortality in the tropics remaining particularly high. In PNG the env ironmental source of C. neoformans remains elusive.