Meningitis - cryptococcal

Definition

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

See also:

• Aseptic meningitis
• Meningitis - gram-negative
• Meningitis -
• Meningitis - meningococcal
• Meningitis - pneumococcal
• Meningitis - staphylococcal
• Meningitis - tuberculous

Alternative Names

Cryptococcal meningitis

Causes, incidence, and risk factors

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 compromised immune systems. Risk factors include:

• AIDS
• Diabetes
• Lymphoma

It occurs in 5 out of 1 million people.

Symptoms

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

Signs and tests

In order to diagnose cryptococcal meningitis, a lumbar puncture (spinal tap) must be performed. This test involves taking a sample of fluid from the spinal column (called cerebrospinal fluid or CSF). The following tests on the CSF allow the health care provider to diagnose cryptococcal meningitis:

• CSF culture
• CSF stains
• CSF test for cryptococcus antigen
• Serum cryptococcal antigen blood test

If you are diagnosed with cryptococcal meningitis, your doctor will also recommend:

• CT scan
• MRI of the head

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.

Expectations (prognosis)

People with AIDS need long-term treatment with medication, to prevent the infection from coming back.

Complications

Obstructive hydrocephalus is a complication. This occurs when the infection disrupts the normal movement of CSF around the brain and spinal cord. A tube called a shunt, which moves CSF around the obstruction, can relieve the pressure.

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

Calling your health care provider

Call the local emergency number (such as 911) or go to the emergency room if you have symptoms of meningitis, or if you are being treated for meningitis and your symptoms get worse.

Go to the emergency room as quickly as possible if you have:

• Changes in your senses or mental state
• Difficulty breathing or swallowing
• Numbness
• Paralysis

References

Kauffman CA. Cryptococcosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 357.