Fungal Infections

October 29, 2008

Cryptococcal meningitis

Cryptococcal meningitis

Alternative names    Return to top

Cryptococcal meningitis

Cryptococcal meningitis is an infection of the meninges (the membranes covering the brain and spinal cord) caused by Cryptococcus neoformans.

Causes, incidence, and risk factors    Return to top

Cryptococcus neoformans is a yeast that is found in soil around the world. Cryptococcal meningitis most often affects people with compromised immune systems. Risk factors include AIDS, lymphoma, and diabetes. It occurs in 5 out of 1 million people.

Symptoms    Return to top

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

  • 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 diagnosis of cryptococcal meningitis: 

  • CSF stains may show the yeast
  • CSF culture grows cryptococcus
  • CSF may be positive for cryptococcus antigen Also, a blood test, the serum cryptococcal antigen test, can be sensitive in diagnosing cryptococcus infection, especially in AIDS patients. 
  • Treatment    Return to top

    Antifungal medications are used to treat this form of meningitis. Intravenous therapy with amphotericin B is the most common treatment. Intrathecal (injection into the spinal cord) medication is sometimes given to people who do not respond to intravenous therapy. An oral medication, fluconazole, in high doses may also be effective against this infection. 

    Expectations (prognosis)    Return to top

    Maintenance therapy must be given to people with AIDS to prevent relapse. 

    Complications    Return to top

    Obstructive hydrocephalus is a complication. This occurs when the CSF is not properly drained, resulting in rising pressures on the brain that can cause temporary or permanent brain damage. Amphotericin B can have severely unpleasant side effects. 

    Calling your health care provider    Return to top

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

    If you have difficulty breathing or swallowing, paralysis, numbness, or sensory or mental state changes, get to the emergency room as quickly as possible. 

     

    Update Date: 7/14/2004

    Medline Plus

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    Cryptococcal Meningitis What is Cryptococcal meningitis?

    Cryptococcal meningitis is a life-threatening infection that can occur if there has been exposure to a fungus called Cryptococcus neoformans. This fungus is found in the environment worldwide, particularly in soil contaminated with bird droppings. This fungus enters the body most commonly through the lungs. Infection does not usually appear until a person’s CD4 counts have dropped below 100. Cryptococcal meningitis can not be passed from one person to another. This fungus most commonly affects the brain, causing the condition called meningitis. Meningitis is an infection and swelling of the lining of the brain and spinal cord. Cryptococcus can also cause infections of the lungs, skin and prostate gland.

    Symptoms: What do I look for?

    Cryptococcal meningitis may be very slow in developing, so at first, very vague symptoms may appear: mild headache, fever, nausea.

    • As the infection progresses, more symptoms will appear if it is not treated:
    • severe headache, nausea with vomiting, blurred vision and/or sensitivity to bright light, stiff neck, seizures, confusion, behaviour changes, coma.
    • Meningitis can be mistaken for other types of brain infections.

    Special tests are needed to confirm Cyptococcal meningitis:

    Lumbar puncture (spinal tap): taking fluid from your spinal column through a needle in your back. This fluid in then sent for special tests. Blood tests: to check whether you have been exposed to the fungus.

    Can Cryptococcal meningitis be prevented?

    Although it is impossible to avoid exposure to this common fungus, people with advanced HIV disease should wear gloves when gardening and generally be careful around bird roosts. At present, there are no proven treatments to prevent this infection, however, studies are in progress. Early detection of the disease and reporting your symptoms is important so that proper treatment can be started.

    How is Cryptococcal meningitis treated?

    When a person is diagnosed with cryptococcal meningitis, treatment with antifungals begins immediately. These medications are usually given intravenously (directly into the vein). Amphotericin B and fluconazole (Diflucan) are the most common drugs used to treat the infection. Once the infection has been treated, it is recommended that the person remain on one of the these drugs for the rest of their lives to prevent the infection from returning again.

    References

    Philips, Peter, (1994) . “Fungal Infections in AIDS Patients”, Grand Rounds in Infectious Diseases, 4, (10), 5-11.

    Sande, Merle & Volberding, Paul, (1992). The Medical Management of AIDS, 3rd ed. Philadelphia: W.B. Saunders Co. White, Mary &

    Armstrong, Donald, (1994). “Cryptococcosis” in Infectious Disease Clinics of North America, 8, (2), 383-398.

     

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