Fungal Meningitis

What Is It?

Fungal meningitis is an infection of the coverings of the brain and spinal cord, the meninges, which is caused by fungus. As with other forms of meningitis, the infection is centered in the cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) in the subarachnoid space. Fungal infection of the meninges is much less common than bacterial meningitis and viral meningitis. It is rare for an otherwise healthy person to develop fungal meningitis. Instead, it is most common in patients who have a weakened immune system, such as patients with AIDS and patients on immunosuppressant drugs after organ transplant.

There are several types of fungi which can cause meningitis. These include:

Cryptococcus neoformans
Histoplasma capsulatum
Coccidioides immitis
Candida albicans
Blastomyces dermatitidis
Aspergillus species
and others

Most of these fungi can be found widely in the environment in various places. While they only rarely cause infection in normal individuals, they can take advantage of a weakened immune system to cause disease. Oftentimes the meningitis occurs after the fungus infects another part of the body and then spreads to the brain.

What Types of Symptoms Are Typical?

Like other forms of meningitis, typical symptoms associated with fungal meningitis include fever and headache, neck stiffness/pain and deterioration of mental status (drowsiness, stupor and coma). Cranial nerve deficits and seizures can also occur. While fungus can cause a rapidly progressive acute meningitis, some forms will lead to a more indolent, chronic infection which progresses slowly, unlike bacterial and viral meningitis.

Some fungal infections can lead to an increased risk for hydrocephalus which can also cause headache and deterioration in mental status.

How Is The Diagnosis Typically Made?

In a patient who presents with symptoms suggestive of meningitis, the neurological examination will generally include a lumbar puncture (spinal tap) to obtain cerebrospinal fluid for analysis. This test can help to identify the presence of infection in the fluid and to identify the causative organism. Special stains and cultures can isolate the causative fungus in most cases. Other neurological testing, such as MRI and CT scan, may be performed as well.

What Are Some Common Treatments?

Treatment of fungal meningitis generally involves administration of antifungal medications. While these are generally administered intravenously, in some severe cases a catheter may be placed into the brain ventricles (fluid filled spaces inside the brain) to allow direct administration of drug into the cerebrospinal fluid. Additionally, in patients who have hydrocephalus, a shunt procedure may be required to treat the hydrocephalus.

Even with treatment fungal meningitis can be quite difficult to control and may lead to significant neurological impairment or death.

Each patient is different. Consult your own physician about the most appropriate treatments for your specific case.

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Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.

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