Meningitis - cryptococcal

Definition

Cryptococcal meningitis is a fungal infection of the tissues covering the brain and spinal cord (meninges).

Alternative Names

Cryptococcal meningitis

Causes

Cryptococcal meningitis is caused by the fungus Cryptococcus neoformans. This fungus is found in soil around the world.

Cryptococcal meningitis most often affects people with a weakened immune system. Risk factors include:

• AIDS
• Cirrhosis (a type of liver disease)
• Diabetes
• Leukemia
• Lymphoma
• Sarcoidosis
• Receiving an organ transplant

It is rare in people who have a normal immune system and no long-term health problems.

Symptoms

Unlike bacterial meningitis, this form of meningitis comes on more slowly, over a few days to a few weeks. Symptoms may include:

• Fever
• Hallucinations
• Headache
• Mental status change
• Nausea and vomiting
• Sensitivity to light (photophobia)
• Stiff neck

Exams and Tests

A doctor or nurse will examine you. This will usually show:

• Fast heart rate
• Fever
• Mental status changes
• Stiff neck

A lumbar puncture ("spinal tap") is an important test for diagnosis meningitis. This test is done to remove a sample of cerebrospinal fluid (CSF).

Tests that may be done include:

• Blood culture
• Chest x-ray
• Cryptococcal antigen in CSF or blood
• CSF examination for cell count, glucose, and protein
• CT scan of the head
• Gram stain, other special stains, and culture of CSF

Treatment

Antifungal medications are used to treat this form of meningitis. Intravenous therapy with amphotericin B is the most common treatment. It is often combined with an oral medication, 5-flucytosine.

An oral medication, fluconazole, in high doses may also be effective against this infection, and may be used later in the course of treatment.

Outlook (Prognosis)

People with AIDS who recover from cryptococcal meningitis need long-term treatment with medication to prevent the infection from coming back and to boost their immune system.

Possible Complications

• Brain damage
• Hearing loss
• Hydrocephalus
• Seizures

Amphotericin B can have side effects, including chills and stiffness, and sometimes kidney damage.

When to Contact a Medical Professional

Call the local emergency number if you develop any of the serious symptoms listed above. Meningitis can quickly become a life-threatening illness.

Call the local emergency number (such as 911) or go to an emergency room if you suspect meningitis in a young child who has the following symptoms:

• Feeding difficulties
• High-pitched cry
• Irritability
• Persistent, unexplained fever

References

Kauffman CA. Cryptococcosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 344.

Thigpen MC, Whitney CG, Messonnier NE, et al. Emerging Infections Programs Network. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011 May 26;364(21):2016-25.

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