Cryptococcal Meningoencephalitis, A Tale of 50 Years.

n 1965, the second year of its existence, the June issue of Indian Pediatrics comprised of 43 pages, and had only six articles. These were: a fluid (CSF) was under increased pressure and appeared turbid. There were 380 lymphocytes/ mm3; the glucose and protein levels were 25 mg/dL and 80 mg/dL, respectively. A wet mount revealed yeast like cells staining positive on India ink preparation. Sabarouds dextrose agar culture media grew budding cryptococci. Bone marrow aspiration was normal. Hematological malignancy, tuberculosis and syphilis were ruled out by absence of abnormal cells in bone marrow and negative Tuberculin and Wassermann’s tests, respectively. Once cryptococcal meningoencephalitis was established, steroids were withheld, and crystalline penicillin and sulphadiazine were given for an unspecified period. There was gradual improvement with the child becoming ambulatory with support by 5 weeks. Subsequently, he was lost to follow-up. The authors recommended that a CSF wet mount examination with India ink should be routinely performed in any suspected chronic meningitis as cryptococcal meningoencephalitis was not as rare as generally believed.