Definition of Meningitis - cryptococcal:

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

See also:

• Aseptic meningitis
• Meningitis - Gram-negative
• Meningitis - H. influenzae
• Meningitis - meningococcal
• Meningitis - pneumococcal
• Meningitis - staphylococcal
• Meningitis - tuberculous

Causes, incidence, and risk factors:

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

Signs 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.

Expectations (prognosis):

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

Complications:

• Brain damage
• Hearing loss
• Hydrocephalus
• Seizures

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

Calling your health care provider:

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