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Meningitis - cryptococcal

Cryptococcal meningitis

 

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

Causes

 

In most cases, CM is caused by the fungus Cryptococcus neoformans. This fungus is found in soil around the world. Cryptococcus gattii can also cause meningitis.

CM most often affects people with a weakened immune system, including people with:

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

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

 

Symptoms

 

This form of meningitis starts slowly, over a few days to a few weeks. Symptoms may include:

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

 

Exams and Tests

 

Your health care provider will examine you. You will likely have a:

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

A lumbar puncture (spinal tap) is used to diagnose meningitis. In this test, a sample of cerebrospinal fluid (CSF) is removed from your spine and tested.

Other tests that may be done include:

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

 

Treatment

 

Antifungal medicines are used to treat this form of meningitis. Intravenous (IV, through a vein) therapy with amphotericin B is the most common treatment. It is often combined with an oral antifungal medicine called 5-flucytosine.

Another oral drug, fluconazole, in high doses may also be effective. If needed, it will be prescribed later.

 

Outlook (Prognosis)

 

People who recover from CM need long-term medicine to prevent the infection from coming back. People with weakened immune systems, such as those with HIV/AIDS, will also need long-term treatment to improve their immune system.

 

Possible Complications

 

These complications may occur from this infection:

  • Brain damage
  • Hearing loss
  • Hydrocephalus (excessive CSF in the brain)
  • Seizures

Amphotericin B can have side effects such as:

  • Nausea and vomiting
  • Fever and chills
  • Joint and muscles aches
  • Kidney damage

 

When to Contact a Medical Professional

 

Call your local emergency number (such as 911) if you develop any of the serious symptoms listed above. Meningitis can quickly become a life-threatening illness.

Call your local emergency number or go to an emergency room if you suspect meningitis in a young child who has these symptoms:

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

 

 

References

Kauffman CA. Cryptococcosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 336.

Perfect JR. Cryptococcosis (Cryptococcus neoformans and Cryptococcus gattii). In: Bennett JE, Dolin R, Blaser MJ eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 264.

US Centers for Disease Control and Prevention. Fungal meningitis. CDC.gov Web site. Updated April 15, 2016. www.cdc.gov/meningitis/fungal.html. Accessed December 5, 2016.

 
  • Central nervous system

    Central nervous system - illustration

    The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

    Central nervous system

    illustration

    • Central nervous system

      Central nervous system - illustration

      The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

      Central nervous system

      illustration

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      Tests for Meningitis - cryptococcal

       

         

        Review Date: 11/27/2016

        Reviewed By: Arnold Lentnek, MD, Infectious Diseases Medical Practice of NY and Clinical Research Centers of CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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