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    Meningitis - cryptococcal

    Cryptococcal meningitis

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

    Causes

    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 a weakened immune system. Risk factors include:

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

    Itis rare in people who havea normal immune system and no long-term health problems.

    Symptoms

    Unlike bacterial meningitis, this form of meningitis comes on more slowly, over a few days to a few weeks. Symptoms may include:

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

    Exams and Tests

    A doctor or nurse will examine you. This will usually show:

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

    A lumbar puncture ("spinal tap") is an important test for diagnosis meningitis. This test is done to remove a sampleofcerebrospinal fluid (CSF).

    Tests that may be done include:

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

    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, and may be used later in the course of treatment.

    Outlook (Prognosis)

    People with AIDS who recover from cryptococcal meningitis need long-term treatment with medication to prevent the infection from coming back and to boost their immune system.

    Possible Complications

    • Brain damage
    • Hearing loss
    • Hydrocephalus
    • Seizures

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

    When to Contact a Medical Professional

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

    Call the local emergency number (such as 911) or go to an emergency room if you suspect meningitis in a young child who has the following symptoms:

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

    References

    Kauffman CA. Cryptococcosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 344.

    Thigpen MC, Whitney CG, Messonnier NE, et al. Emerging Infections Programs Network. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011 May 26;364(21):2016-25.

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        Tests for Meningitis - cryptococcal

          Review Date: 10/7/2012

          Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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