Cryptococcal Meningitis in Post-COVID Era: A Case Series

Meningitis, defined as inflammation of the meninges surrounding the brain and spinal cord, can arise from a broad spectrum of infectious and non infectious causes. Among infectious aetiologies, fungal meningitis is less common but poses significant morbidity and mortality. Cryptococcal meningitis, a life-threatening fungal infection primarily affecting immunocompromised individuals, has shown an increased incidence in the post-Coronavirus Disease-2019 (COVID-19) era. Immune dysregulation caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and the widespread use of immunosuppressive therapies are suspected contributors to this rise. The first case was a 47-year-old Human Immunodeficiency Virus (HIV)-positive man on tuberculosis treatment who presented with meningitis symptoms; India ink preparation showed a yeast cell with a refractile halo. The second case was a 75-year-old man with a prior COVID-19 infection who developed meningitis and was diagnosed with cryptococcal meningitis. The third case was a 37-year-old asthmatic female on steroids with a history of COVID-19 who presented with headache and altered sensorium. Cerebrospinal Fluid (CSF) was collected and sent for investigation. India ink showed encapsulated yeast cells and culture showed Gram-positive budding yeast cells. The fourth case was a 50-year-old male with chronic kidney disease who presented with fever, neck stiffness and altered sensorium. Gram stain of CSF and India ink preparation both showed Cryptococcus. All patients were treated with amphotericin B and fluconazole, with favourable clinical outcomes. Clinicians should maintain a high index of suspicion for opportunistic fungal infections in patients with recent COVID-19 or immunosuppressive therapy.