Fungal meningitis

Meningitis caused by a fungal infection

Medical condition

Fungal meningitis

Fungus (black) in brain tissue
Specialty| Infectology, neurology

Fungal meningitis refers to meningitis caused by a fungal infection.

## Signs and symptoms

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See also: Meningitis

Symptoms of fungal meningitis are generally similar to those of other types of meningitis, and include: a fever, stiff neck, severe headache, photophobia (sensitivity to light), nausea and vomiting, and altered mental status (drowsiness or confusion).[1][2]

## Causes

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Fungal meningitis may be caused by the following (and also other) types of fungi:[1][2][3]

* Candida \- C. albicans is the most common Candida species that causes infections of the central nervous system.
* Coccidioides \- it is endemic to southwestern United States and Mexico. A third of patients presenting with disseminated coccidioidomycosis have developed meningitis.
* Histoplasma \- occurs in bird and bat droppings and is endemic to parts of the United States, South, and Central America. Involvement of the central nervous system occurs in about 10-20% of cases of disseminated histoplasmosis.
* Blastomyces \- occurs in soil rich in decaying organic matter in the Midwest United States. Meningitis is an unusual manifestation of blastomycosis and can be very difficult to diagnose.
* Cryptococcus (Cryptococcal meningitis) - it is thought to be acquired through inhalation of soil contaminated with bird droppings. C. neoformans is the most common pathogen to cause fungal meningitis.
* Aspergillus \- Aspergillus infections account for 5% of fungal infections involving the central nervous system.

## Risk factors

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Individuals with a weak immune system are most at risk. This includes individuals taking immunosuppressive medication, cancer patients, HIV patients, premature babies with very low birth weight,[2][3] and the elderly.[4]

People who are at an increased risk of acquiring particular fungal infections in general may also be at an increased risk of developing fungal meningitis, as the infection may in some cases spread to the central nervous system. People residing in the Midwestern United States, and Southwestern United States and Mexico are at an increased risk of infection with Histoplasma and Coccidioides, respectively.[2][3]

## Diagnosis

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If suspected, fungal meningitis is diagnosed by testing blood and cerebrospinal fluid for pathogens. Identifying the specific pathogen is necessary to determine the proper course of treatment and the prognosis.[2] Measurement of opening pressure, cell count with differential, glucose and protein concentrations, Gram's stain, India ink, and culture tests should be performed on cerebrospinal fluid when fungal meningitis is suspected.[3]

## Treatment

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Fungal meningitis is treated with long courses of high dose antifungal medications. The duration of treatment is dependent upon the causal pathogen and the patient's ability to stave off the infection; for patients with a weaker immune system or diabetes, treatment will often take longer.[2]

## Prognosis

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Prognosis depends on the pathogen responsible for the infection and risk group. Overall mortality for Candida meningitis is 10-20%, 31% for patients with HIV, and 11% in neurosurgical cases (when treated). Prognosis for Aspergillus and coccidioidal infections is poor.[3]

## Outbreaks

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E. Rostratum

Main article: New England Compounding Center meningitis outbreak

As of November 5, 2012, the CDC reported that 409 patients had laboratory-confirmed fungal meningitis caused by injections with contaminated medication. There had been 30 fatalities. A black mold, Exserohilum rostratum, was found in 45 of these cases. Aspergillus fumigatus was found in one case, and a Cladosporium species was found in one case.[5]

Aspergillus has been very rarely associated with meningitis[6] while cases caused explicitly by Exserohilum in otherwise healthy individuals have not been previously reported.[7]

In Early 2023, cases of fungal meningitis were attributed to patients that received cosmetic surgery in Matamoros Mexico. [8]

## See also

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* Meningitis
* Chronic meningitis
* Cryptococcal meningitis

## References

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1. ^ a b "Meningitis". Paediatrics & Child Health. 6 (3): 126–7. March 2001. doi:10.1093/pch/6.3.126. PMC 2804524. PMID 20084221.
2. ^ a b c d e f "Meningitis Fungal Meningitis". www.cdc.gov. Retrieved 29 November 2017.
3. ^ a b c d e Gottfredsson M, Perfect JR (2000). "Fungal meningitis". Seminars in Neurology. 20 (3): 307–22. doi:10.1055/s-2000-9394. PMID 11051295. S2CID 37046726.
4. ^ Sirven JI, Malamut BL (2008). Clinical neurology of the older adult (2nd ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 978-0-7817-6947-1. OCLC 169452993.
5. ^ "Current Situation:CDC Responds to Multistate Fungal Meningitis Outbreak". CDC. 18 October 2012. Retrieved 21 October 2012.
6. ^ Badiee P, Alborzi A (November 2011). "Assessment of a real-time PCR method to detect human non-cryptococcal fungal meningitis" (PDF). Archives of Iranian Medicine. 14 (6): 381–4. PMID 22039841.
7. ^ Adler A, Yaniv I, Samra Z, Yacobovich J, Fisher S, Avrahami G, Levy I (April 2006). "Exserohilum: an emerging human pathogen". European Journal of Clinical Microbiology & Infectious Diseases. 25 (4): 247–53. doi:10.1007/s10096-006-0093-3. PMID 16511679. S2CID 11489934.
8. ^ "Suspected Fungal Meningitis Outbreak Associated with Procedures Performed under Epidural Anesthesia in Matamoros, Mexico | HAI | CDC". www.cdc.gov. 2023-05-24. Retrieved 2023-05-26.

## External links

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Classification|

* MeSH: D016921

|

* v
* t
* e

Fungal infection and mesomycetozoea

Superficial and
cutaneous
(dermatomycosis):
Tinea = skin;
Piedra (exothrix/
endothrix) = hair|

| Ascomycota|

| Dermatophyte
(Dermatophytosis)|

| By location|

* Tinea barbae/tinea capitis
* Kerion
* Tinea corporis
* Ringworm
* Dermatophytids
* Tinea cruris
* Tinea manuum
* Tinea pedis (athlete's foot)
* Tinea unguium/onychomycosis
* White superficial onychomycosis
* Distal subungual onychomycosis
* Proximal subungual onychomycosis
* Tinea corporis gladiatorum
* Tinea faciei
* Tinea imbricata
* Tinea incognito
* Favus

|

By organism|

* Epidermophyton floccosum
* Microsporum canis
* Microsporum audouinii
* Trichophyton interdigitale/mentagrophytes
* Trichophyton tonsurans
* Trichophyton schoenleini
* Trichophyton rubrum
* Trichophyton verrucosum

Other|

* Hortaea werneckii
* Tinea nigra
* Piedraia hortae
* Black piedra

Basidiomycota|

* Malassezia furfur
* Tinea versicolor
* Malassezia folliculitis
* Trichosporon
* White piedra

Subcutaneous,
systemic,
and opportunistic|

| Ascomycota|

| Dimorphic
(yeast+mold)|

| Onygenales|

* Coccidioides immitis/Coccidioides posadasii
* Coccidioidomycosis
* Disseminated coccidioidomycosis
* Primary cutaneous coccidioidomycosis. Primary pulmonary coccidioidomycosis
* Histoplasma capsulatum
* Histoplasmosis
* Primary cutaneous histoplasmosis
* Primary pulmonary histoplasmosis
* Progressive disseminated histoplasmosis
* Histoplasma duboisii
* African histoplasmosis
* Lacazia loboi
* Lobomycosis
* Paracoccidioides brasiliensis
* Paracoccidioidomycosis

|

Other|

* Blastomyces dermatitidis
* Blastomycosis
* North American blastomycosis
* South American blastomycosis
* Sporothrix schenckii
* Sporotrichosis
* Talaromyces marneffei
* Talaromycosis
* Scedosporiosis
* Emmonsiosis
* Emmonsia parva
* Adiaspiromycosis

Yeast-like|

* Candida albicans
* Candidiasis
* Oral
* Esophageal
* Vulvovaginal
* Chronic mucocutaneous
* Antibiotic candidiasis
* Candidal intertrigo
* Candidal onychomycosis
* Candidal paronychia
* Candidid
* Diaper candidiasis
* Congenital cutaneous candidiasis
* Perianal candidiasis
* Systemic candidiasis
* Erosio interdigitalis blastomycetica
* C. auris
* C. glabrata
* C. lusitaniae
* C. tropicalis
* Pneumocystis jirovecii
* Pneumocystosis
* Pneumocystis pneumonia

Mold-like|

* Aspergillus
* Aspergillosis
* Aspergilloma
* Allergic bronchopulmonary aspergillosis
* Primary cutaneous aspergillosis
* Exophiala jeanselmei
* Eumycetoma
* Fonsecaea pedrosoi/Fonsecaea compacta/Phialophora verrucosa
* Chromoblastomycosis
* Geotrichum candidum
* Geotrichosis
* Pseudallescheria boydii
* Allescheriasis

Basidiomycota|

* Cryptococcus neoformans
* Cryptococcosis
* Trichosporon spp
* Trichosporonosis

Zygomycota
(Zygomycosis)|

| Mucorales
(Mucormycosis)|

* Rhizopus oryzae
* Mucor indicus
* Lichtheimia corymbifera
* Syncephalastrum racemosum
* Apophysomyces variabilis

|

Entomophthorales
(Entomophthoramycosis)|

* Basidiobolus ranarum
* Basidiobolomycosis
* Conidiobolus coronatus/Conidiobolus incongruus
* Conidiobolomycosis

Microsporidia
(Microsporidiosis)|

* Enterocytozoon bieneusi/Encephalitozoon intestinalis

Mesomycetozoea|

* Rhinosporidium seeberi
* Rhinosporidiosis

Ungrouped|

* Alternariosis
* Fungal folliculitis
* Fusarium
* Fusariosis
* Granuloma gluteale infantum
* Hyalohyphomycosis
* Otomycosis
* Keratomycosis
* Phaeohyphomycosis

* v
* t
* e

Meningitis and other diseases of meninges

Meningitis|

* Arachnoiditis
* Bacterial
* Tuberculous
* Haemophilus
* Pneumococcal
* Viral
* Herpesviral
* Fungal
* Cryptococcal
* Aseptic
* Drug-induced

Other|

* Meningoencephalitis

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