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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.
Meningitis
Meningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the 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:
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AIDS
AIDS
Human immunodeficiency virus (HIV) is the virus that causes AIDS. When a person becomes infected with HIV, the virus attacks and weakens the immune ...
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Diabetes
Diabetes
Diabetes is a chronic disease in which the body cannot regulate the amount of sugar in the blood.
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Lymphoma
Lymphoma
Hodgkin lymphoma is a cancer of lymph tissue. Lymph tissue is found in the lymph nodes, spleen, liver, bone marrow, and other sites.
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- 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
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Hallucinations
Hallucinations
Hallucinations involve sensing things such as visions, sounds, or smells that seem real but are not. These things are created by the mind.
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Mental status change
(confusion)
Mental status change
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
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- 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.
Spinal tap
Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...
Other tests that may be done include:
- Blood culture
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Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
ImageRead Article Now Book Mark Article - Cryptococcal antigen in CSF or blood, to look for antibodies
- CSF examination for cell count, glucose, and protein
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CT scan of the head
CT scan of the head
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
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Gram stain, other special stains, and
culture of CSF
Culture of CSF
A cerebrospinal fluid (CSF) culture is a laboratory test to look for bacteria, fungi, and viruses in the fluid that moves in the space around the spi...
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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.
Intravenous
Intravenous means "within a vein. " Most often it refers to giving medicines or fluids through a needle or tube inserted into a vein. This allows th...
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
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Hearing loss
Hearing loss
Hearing loss is being partly or totally unable to hear sound in one or both ears.
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Hydrocephalus
(excessive CSF in the brain)
Hydrocephalus
Hydrocephalus is a buildup of fluid inside the skull that leads to brain swelling. Hydrocephalus means "water on the brain. "
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Seizures
Seizures
A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. The term "seizure...
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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.
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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
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.
