Cryptococcal meningitis in two apparently immunocompetent Maltese patients

Two cases of cryptococcal meningitis occurring in immunocompetent men are described. The first case involves a farmer in whom cryptococcal meningitis was rapidly diagnosed using direct microscopy, latex antigen tests and culture of cerebrospinal fluid (CSF). In the second case, initial mycological tests on CSF (direct microscopy and culture) were repetitively negative and latex antigen tests gave unconvincing results. The patient was started on triple antituberculosis therapy, on which he improved immediately; therapy was continued for 1 year with the patient remaining well. However, within 1 week of stopping therapy, he had to be readmitted with neurological signs and symptoms. Culture of CSF this time yielded Cryptococcus neoformans and the antigen test was consistently positive. These are the first reported cases of cryptococcal meningitis in immunocompetent patients in Malta.