Anak Agung Ayu Suryapraba Indradewi

Cryptococcal meningitis is a rare disease caused by Cryptococcus neoformans or Cryptococcus gatii as the fungal pathogen in humans. The disease is highly prevalence in people living with human immunodeficiency virus (HIV) and is the major cause of mortality in an immunocompromised individual. This life-threatening disease does not often occur with specific signs and symptoms. We reported a case of an early adulthood HIV-infected patient with a mild headache and low-grade fever. There were no altered mental status or other significant specific manifestations. Blood examination, chest radiograph, and computed tomography scan revealed no significant results. C. neoformans were isolated from a culture of the cerebrospinal fluid specimen as the conventional gold standard examination for cryptococcal meningitis. A positive result was confirmed in the India ink staining preparation. The patient was treated with fluconazole monotherapy for the induction and consolidation phase and showed a positive disease progression during observations.

BACKGROUND: Human infection of Streptococcus suis in Indonesia was increasing in the following years. Many cases presented with meningitis and sepsis, but in the current case, we presented a rare case of meningitis S. suis infection with spondylodiscitis. CASE REPORT: A 60-year-old man, Balinese, presented with the 3-day onset of fever, headache, and nausea. Three-hour before admission, he became agitated and decreased of consciousness. He had a history of pork consumption 4 days before admission. He was subsequently diagnosed with acute bacterial meningitis and sensorineural hearing impairment. In the next 2 weeks, he developed low back pain, confirmed as spondylodiscitis from magnetic resonance imaging, a less common presentation of S. suis infection. After 4-week intravenous ceftriaxone treatment, he improved significantly with only hearing impairment remaining. CONCLUSION: Meningitis suis is a systemic infection which can manifest in any organ. The clinician should suspect any low back pain as spondylodiscitis in a patient who had S. suis meningitis.