Ocular Findings of Cryptococcal Meningitis in Previously Healthy Adults.

BACKGROUND: Patients with cryptococcal meningitis (CM) often have ocular manifestations; although data are describing these findings in nonimmunosuppressed, previously healthy individuals are scarce. METHODS: A retrospective chart review was performed for previously healthy patients with CM who underwent a complete ophthalmological examination within a 5-year period at the National Institutes of Health. Demographics, CSF parameters, findings on initial ophthalmological examination, and MRI abnormalities were analyzed. RESULTS: Forty-four patients within a median of 12 weeks after CM diagnosis were included in our study; 27 patients (61%) reported abnormal vision on presentation. Seventy-one percent of patients were not shunted at the time of their initial eye examination. The most common ocular abnormalities were visual field defects in 21 (66%), decreased visual acuity in 14 (38%), and papilledema in 8 (26%) patients. Intraocular pressure was within normal range in all patients. Cranial nerve defects were identified in 5 patients and optic neuropathy in 2 patients. Patients who had hydrocephalus or did not receive a ventriculoperitoneal shunt were not noted to have worse ocular abnormalities. CONCLUSIONS: The most common ocular findings in our cohort of nontransplant, non-HIV cryptococcal meningitis patients were visual field defects, decreased visual acuity, and papilledema. Our results emphasize the need for a comprehensive eye examination in patients with CM who may not always report a change in vision on presentation.

Possible discovery of Chinese lung fluke, Paragonimus skrjabini in Manipur, India.

To obtain more information about Paragonimus species prevalent in Manipur, India, hundreds of freshwater crabs, Potamiscus manipurensis, were captured from mountain streams in the Motbung Mountains in Senapati District, from December 1997 to January 1998. Crab extracts were prepared by digestion, differential filtration, and sedimentation. The filtered sediments were critically examined under a stereomicroscope. Isolated Paragonimus metacercariae were used for morphological study and animal experimentation. Forty-seven metacercariae were fed orally to a 3-month-old male puppy of local breed; at autopsy 155 days after inoculation, 12 adult worms were recovered; 2 were free in the thoracic cavity and 5 pairs were in lung cysts. Two adult worms were flattened and fixed in 70% ethanol and the remaining worms were put directly into 70% ethanol and preserved until July 2005. The former 2 worms were stained with borax carmine for morphological study at Sikkim Manipal Institute of Medical Sciences, Sikkim, India. Two adult worms in the latter group were sent to the National Institute of Infectious Diseases, Tokyo, Japan, for morphological identification and DNA sequencing. The morphological features of the borax carmine-stained worms were characteristic of P. skrjabini, although no genetic material for PCR amplification and sequencing could be extracted from the worm.