Meningitis - cryptococcal

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
• Diabetes
• Lymphoma

In people with a normal immune system and no chronic illnesses, it is a rare condition.

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

Physical examination will usually show:

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

For any patient who is suspected of having meningitis, it is important to perform a lumbar puncture ("spinal tap"), in which spinal fluid (known as cerebrospinal fluid, or CSF) is collected for testing.

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.

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

Alternative Names

Cryptococcal meningitis

References

Kauffman CA. Cryptococcosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 357.

Update Date: 9/15/2010

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Jatin M. Vyas, PhD, MD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.