Summary about Disease
Fungal meningitis is a rare form of meningitis, an inflammation of the membranes (meninges) and fluid surrounding the brain and spinal cord. Unlike more common bacterial or viral meningitis, it is caused by a fungal infection. It is typically not contagious and often develops slowly.
Symptoms
Symptoms of fungal meningitis can be similar to those of other types of meningitis but may develop more gradually. Common symptoms include:
Headache
Fever
Stiff neck
Nausea
Vomiting
Sensitivity to light (photophobia)
Confusion or altered mental status
Seizures
Causes
Fungal meningitis is caused by different types of fungi. The most common causes include:
Cryptococcus species (e.g., *Cryptococcus neoformans*, *Cryptococcus gattii*)
Histoplasma
Coccidioides
Blastomyces
Candida (rarely)
Aspergillus (rarely) These fungi can enter the body through inhalation (e.g., fungal spores in soil), and in some cases, spread from other parts of the body to the brain and spinal cord. Outbreaks can sometimes be linked to contaminated medications, such as contaminated injectable methylprednisolone.
Medicine Used
Treatment for fungal meningitis typically involves long-term antifungal medications. Common medications include:
Amphotericin B (often as an initial, intensive treatment)
Flucytosine (often used in combination with amphotericin B)
Fluconazole
Voriconazole
Itraconazole The specific medication and duration of treatment depend on the type of fungus causing the infection and the severity of the illness.
Is Communicable
Fungal meningitis is generally not communicable from person to person. Most cases occur due to exposure to fungi in the environment. The exception would be if it was due to a contaminated medication, in which case, many individuals could get the same infection from that source, but the infection would not spread between the people.
Precautions
Since fungal meningitis is not typically contagious, standard infection control measures are usually sufficient. These include:
Good hygiene practices (e.g., handwashing)
Avoiding known sources of fungal exposure (e.g., areas with high concentrations of bird or bat droppings for Histoplasma)
For healthcare settings, appropriate handling and preparation of injectable medications are crucial to prevent outbreaks.
How long does an outbreak last?
The duration of an outbreak of fungal meningitis varies widely, depending on the source and the effectiveness of control measures. Outbreaks linked to contaminated medications can last for several months or even years, as identifying and removing the source of contamination can be a complex process. Sporadic cases, not linked to a specific outbreak, do not have a set duration.
How is it diagnosed?
Diagnosis typically involves:
Lumbar puncture (spinal tap): Cerebrospinal fluid (CSF) is collected and analyzed.
CSF analysis: Examining the CSF for fungal organisms, increased white blood cell count, elevated protein levels, and decreased glucose levels.
Fungal cultures: Growing fungi from CSF samples to identify the specific organism.
Imaging studies: MRI or CT scans of the brain may be performed to look for abnormalities.
Blood tests: Can help to identify fungal infections elsewhere in the body.
Antigen tests: These tests can detect fungal antigens (substances that trigger an immune response) in the CSF or blood.
Timeline of Symptoms
The timeline of symptoms can vary. Some experience a rapid onset, while others develop symptoms more gradually over days to weeks.
Early stages: Mild headache, low-grade fever, fatigue.
Later stages: Stiff neck, worsening headache, photophobia, nausea, vomiting, confusion, seizures. The progression of symptoms is typically slower than with bacterial meningitis.
Important Considerations
Early diagnosis and treatment are crucial to prevent severe complications and improve outcomes.
Fungal meningitis can be life-threatening, especially in individuals with weakened immune systems.
Individuals with risk factors (e.g., HIV/AIDS, organ transplant recipients, those taking immunosuppressant medications) should be particularly vigilant for symptoms.
Consult a healthcare professional immediately if you suspect you may have meningitis.
Long-term antifungal therapy and follow-up are often necessary to ensure complete eradication of the infection.