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 meningitis in Pap ua New Guinea, affecting apparently immunocompetent people. The majori ty of infections are believed to be due to Cryptococcus neoformans var . gattii. We have reviewed the records of 49 Melanesian adults who pre sented with proven cryptococcal meningitis to the University teaching hospital in Port Moresby, and compare our findings with other publishe d studies of cryptococcal meningitis in the tropics and sub-tropics. N one of the patients had an obvious cause of immunosuppression. Visual disturbances and fundoscopic changes of papilloedema or papillitis wer e particularly common. The in-hospital case fatality rate for patients treated with amphotericin B and flucytosine was 22.4%. Of the fully t reated patients, 31% became completely blind before being discharged f rom hospital. Therapy directly aimed at reducing intracranial pressure may improve outcome.