Fungal meningitis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Typically presents as a progressive, life-threatening, chronic or subacute meningitis.
Occurs most commonly in immunosuppressed individuals and is often accompanied by systemic involvement.
Cerebrospinal fluid (CSF) typically shows lymphocytic pleocytosis, elevated protein, and low glucose.
The most common type of fungal meningitis is caused by Cryptococcus neoformans.
A rapid etiologic diagnosis is required to guide antifungal therapy.

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History & Exam
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Cryptococcal meningoencephalitis. (A) Cranial magnetic resonance imaging (MRI) shows cerebellar hyperintensities (arrows) in FLAIR sequences (fluid-attenuated inversion recovery) and (B) meningeal contrast enhancement (arrows) in T1 weighted MRI. (C) Indian ink stain, (D) fungal culture, and (E) Gram stain of cerebrospinal fluid were positive

Citations

Key Articles

Johnson RH, Einstein HE. Coccidioidal meningitis. Clin Infect Dis. 2006 Jan 1;42(1):103-7.[Abstract][Full Text]
World Health Organization. Guidelines for diagnosing, preventing and managing cryptococcal disease among adults, adolescents and children living with HIV. June 2022 [internet publication].[Abstract][Full Text]
National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association of the Infectious Disease Society of America. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. September 2022 [internet publication].[Full Text]
Galgiani JN, Ampel NM, Blair JE, et al. 2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis. Clin Infect Dis. 2016 Sep 15;63(6):e112-46.[Abstract][Full Text]
Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4):e1-50.[Abstract][Full Text]
Johnson RH, Einstein HE. Coccidioidal meningitis. Clin Infect Dis. 2006 Jan 1;42(1):103-7.[Abstract][Full Text]
Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Aug 15;63(4):e1-60.[Abstract][Full Text]

Other Online Resources

Fungus Education Hub: interim recommendations for diagnosis and management of cases of fungal meningitis associated with epidural anesthesia administered in Matamoros, Mexico

Referenced Articles

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