Meningitis - cryptococcal
Cryptococcal meningitisFor new patient appointments, call 336-716-WAKE (9253) or request an appointment online.
Cryptococcal meningitis is a fungal infection of the tissues covering the brain and spinal cord. These tissues are called meninges.
Causes
In most cases, cryptococcal meningitis is caused by the fungus Cryptococcus neoformans. This fungus is found in soil around the world. Cryptococcus gattii can also cause meningitis.
This type of meningitis is not spread from person to person. Usually, it spreads through the bloodstream to the brain from another place in the body that has the infection.
Cryptococcal meningitis most often affects people with a weakened immune system, including people with:
The disease 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 and ask about your symptoms.
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 in the disease course.
Outlook (Prognosis)
People who recover from cryptococcal meningitis 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 or vision loss
- Hydrocephalus (excessive CSF in the brain)
- Seizures
- Death
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
Centers for Disease Control and Prevention website. Fungal meningitis. www.cdc.gov/meningitis/fungal.html. Updated April 15, 2016. Accessed December 14, 2018.
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 Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 264.
