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Cryptococcosis is now the most common cause of adult meningitis in much of Southern and East Africa [1]. Despite currently available antifungal therapies, acute mortality ranges from 30% to over 50% in published series [2, 3]. The result is that cryptococcal infection accounts for 10–20% of mortality in HIV-infected cohorts from sub-Saharan Africa [1], and recently published estimates by Park et al.[4] place the overall toll at an estimated 504 000 deaths in sub-Saharan Africa annually.

As part of an ongoing programme of work aimed at improving management of cryptococcal meningitis, we have prospectively monitored the number of new India ink positive cases of cryptococcal meningitis diagnosed at GF Jooste Hospital, Cape Town, South Africa, for the last 6 years (2003–2008). This is a public sector adult hospital serving a population of 1.3 million (including a large part of Khayelitsha township, population 500 000 …