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BackgroundCryptococcus neoformans is saprophytic encapsulated yeast. Infection is acquired by inhalation of the organism and could be asymptomatic or limited to the lungs, specially in the immunocompetent host. Cryptococcal meningitis is a serious opportunistic infection among post transplant recipients. Cranial nerve palsies and ophthalmoplegia are well known complications of this disease, but bilateral complete ophthalmoplegia is a very rare presentation.Case PresentationA Sri Lankan young male, who is a post kidney transplant recipient, presented with bilateral complete ophthalmoplegia and subsequently was diagnosed to have cryptococcal meningitis based on Indian ink stain and culture of cerebrospinal fluid (CSF). His magnetic resonance imaging (MRI) showed bilateral multiple nodular lesions in both basal ganglia and thalami. Brainstem imaging was normal.ConclusionsCryptococcal meningitis is a serious fungal infection in post transplant patients. It should be suspected in any immunocompromised patient with fever, headache and focal neurological signs. Bilateral thalamic lesions, inflammation and invasion of the cranial nerves and raised intracranial pressure were thought to be possible mechanisms resulting in bilateral complete ophthalmoplegia in this patient.

IntroductionIsolated cranial nerve palsies are considered to be an uncommon presenting feature of multiple sclerosis. Involvement of the trigeminal nerve, particularly its motor component as part of a clinically isolated syndrome of multiple sclerosis has rarely been reported in equatorial regions and no cases have been described in Sri Lanka thus far.Case PresentationWe report a case of isolated right sided trigeminal nerve palsy (Motor and Sensory) in a 34 year old previously well lady from urban Sri Lanka who was found to have characteristic lesions on Magnetic Resonance Imaging highly suggestive of multiple sclerosis.ConclusionsMultiple sclerosis should be considered in the differential diagnosis of patients who present with isolated cranial nerve palsies. Clinicians should have a high index of suspicion when evaluating such patients especially in low prevalence regions close to the equator. Early recognition and treatment of such a “Clinically Isolated Syndrome” may prevent early relapse.

Anaesthetists are a group of doctors who are at a higher occupational risk of contracting blood borne infections as they perform many invasive procedures. Practice of Universal Precautions (UP) is vital in reducing the risk of transmission. The objective of this study was to assess the knowledge and compliance among anaesthetists of the National Hospital of Sri Lanka (NHSL) on UP and related issues. Information was collected from 97 anaesthetists at the NHSL using a structured questionnaire. Knowledge and practice of UP was assessed separately through specific questions. The average percentage mark of the 97 respondents on their knowledge on UP was 77.43% with a standard deviation of 13.84. Approximately, 68% of the respondents obtained above-average marks. With regard to practise of UP, 61% of the respondents had their total coded mark within the range from 14 to 16 out of the possible maximum of 21. There was no significant correlation between knowledge and practice. Only 15% of the population wore gloves during all procedures at OT, and 46% has stated that it is comfortable to work without gloves as the reason for not wearing. Based on these results, it is concluded that there is appreciable room for improvement of knowledge and practice of UP among anaesthetists. The study further revealed that knowledge and practice of UP is not related to gender or experience, which indicated that it is probably a personal trait of each respondent, depending on the discipline and application of each individual.