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Meningitis - cryptococcal

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:

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:

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:

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:

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

Alternative Names

Cryptococcal meningitis

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.

Review Date 11/27/2016

Updated 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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