Wye-Hong Leong

Cryptococcal meningitis (CM) is a relatively uncommon infection among immunocompetent individuals, with high rates of morbidity and mortality. We describe a 41-year-old seemingly immunocompetent gentleman with no significant past medical history who presented with fever, altered mental status, and headache for one week. The initial lumbar puncture (LP) exhibited lymphocytic pleocytosis with elevated cerebrospinal fluid (CSF) protein. CSF samples tested negative for common bacterial and viral pathogens; however, cryptococcal antigen was not tested. The patient was subsequently intubated for airway protection due to further deterioration in his mental status. Repeated CSF analysis tested positive for cryptococcal antigen with positive Indian ink microscopy. In spite of urgent surgical CSF diversion and combination antifungal therapy, the patient subsequently succumbed to his illness. This case highlights the great challenge in ensuring early and accurate diagnosis of CM, especially in immunocompetent patients who often present with indolent clinical manifestations. Greater emphasis should be placed on the importance of early diagnosis of CM and prompt initiation of effective treatment for better prognosis. This case underscores the critical need to include point-of-care cryptococcal antigen (CrAg) testing in the initial workup of all patients with unexplained lymphocytic pleocytosis, irrespective of their perceived immune status. Future research should be conducted to refine diagnostic approaches and treatment strategies for immunocompetent patients with CM.

Antimicrobial resistance (AMR) has been identified as one of the biggest health threats in the world. Current therapeutic options for common infections are markedly limited due to the emergence of multidrug resistant pathogens in the community and the hospitals. The role of different essential oils (EOs) and their derivatives in exhibiting antimicrobial properties has been widely elucidated with their respective mechanisms of action. Recently, there has been a heightened emphasis on lavender essential oil (LEO)’s antimicrobial properties and wound healing effects. However, to date, there has been no review published examining the antimicrobial benefits of lavender essential oil, specifically. Previous literature has shown that LEO and its constituents act synergistically with different antimicrobial agents to potentiate the antimicrobial activity. For the past decade, encapsulation of EOs with nanoparticles has been widely practiced due to increased antimicrobial effects and greater bioavailability as compared to non-encapsulated oils. Therefore, this review intends to provide an insight into the different aspects of antimicrobial activity exhibited by LEO and its constituents, discuss the synergistic effects displayed by combinatory therapy involving LEO, as well as to explore the significance of nano-encapsulation in boosting the antimicrobial effects of LEO; it is aimed that from the integration of these knowledge areas, combating AMR will be more than just a possibility.