About Fungal Meningitis

* Source: Centers for Disease Control (CDC)

Fungal meningitis is rare, but can be life threatening. Although anyone can get fungal meningitis, people at higher risk include those who have AIDS, leukemia, or other forms of immunodeficiency (an immune system that does not respond adequately to infections) and immunosuppression (immune system malfunction as a result of medical treatment).

The most common cause of fungal meningitis for people with immune system deficiencies, like HIV, is Cryptococcus. This disease is one of the most common causes of meningitis in Africa.

The fungus that causes thrush, Candida, can lead to meningitis in rare cases, especially in pre-mature babies with very low birth weight.

Meningitis due to Histoplasma can happen in anybody, but people with immunodeficiencies are at a higher risk. Histoplasma is found primarily in soil or bird/bat droppings in the Midwestern United States, although it can be seen in other places.

Soil in Southwestern United States and northern Mexico contain the fungus Coccidioides which can cause fungal meningitis. Although anyone can get infected with coccidioidal meningitis, people at higher risk include African Americans, Filipinos, pregnant women in the third trimester, and immunocompromised persons.
Risk Factors

There are certain diseases, medications and surgical procedures that may weaken the immune system and increase risk of fungal meningitis. Pre-mature babies with very low birth weights are also at increased risk.

Living in certain areas of the U.S. may increase one's risk. For example, bird/bat droppings in the Midwestern United States and soil in the Southwestern United States are more likely to contain a fungus that can cause meningitis.
Transmission

Fungal meningitis is not contagious. It is not transmitted from person to person. People at risk for fungal meningitis acquire the infection usually by inhaling fungal spores from the environment. People with certain medical conditions like diabetes, cancer, or HIV are at higher risk of fungal meningitis. You may also get fungal meningitis after taking medications that weaken your immune system. Examples of these medications include steroids (such as prednisone), medications given after organ transplantation, or anti-TNF medications, which are sometimes given for treatment of rheumatoid arthritis or other autoimmune conditions.

Cryptococcus is felt to be acquired through inhaling soil contaminated with bird droppings, and Histoplasma is found in environments with heavy contamination of bird or bat droppings, particularly in the Midwest near the Ohio and Mississippi Rivers. The Midwest United States, particularly the northern Midwest, is endemic to the fungus Blastomyces. This fungus is thought to exist in soil rich in decaying organic matter. Coccidioides is found in the soil of endemic areas (Southwestern US and parts of Central and South America). When these environments are disturbed, the fungal spores can be inhaled. Meningitis results from the fungal infection spreading to the spinal cord.

Candida is usually acquired in a hospital setting. Fungal meningitis is rare and usually is the result of spread by the fungus through the blood to the spinal cord. 

Signs & Symptoms

Meningitis infection is characterized by a sudden onset of fever, headache, and stiff neck. It is often accompanied by other symptoms, such as

    Nausea
    Vomiting
    Photophobia (sensitivity to light)
    Altered mental status

Symptoms of fungal meningitis are similar to symptoms of other forms of meningitis; however, they often appear more gradually. In addition to typical meningitis symptoms, like headache, fever, nausea, and stiffness of the neck, people with fungal meningitis may also experience:

    Dislike of bright lights
    Changes in mental status, confusion
    Hallucinations
    Personality changes
 

Diagnosis

If meningitis is suspected, samples of blood or cerebrospinal fluid (near the spinal cord) are collected and sent to the laboratory for testing. It is important to know the specific cause of meningitis because the severity of illness and the treatment will differ depending on the cause.

To confirm fungal meningitis, specific lab tests can be performed, depending on the type of fungus suspected.
Treatment

Fungal meningitis is treated with long courses of high dose antifungal medications. This is usually given using an IV line and is done in the hospital. The length of treatment depends on the status of the immune system and the type of fungus that caused the infection. For people with immune systems that do not function well because of other conditions, like AIDS, diabetes, or cancer, there is often a need for longer treatment.
Prevention

There is little evidence that specific activities can lead to developing fungal meningitis, although avoiding exposure to environments likely to contain fungal elements is prudent. People who are immunosuppressed (for example, those with HIV infection) should try

to avoid bird droppings and avoid digging and dusty activities, particularly if they live in a geographic region where fungi like Histoplasma, Coccidioides, or Blastomyces species exist. HIV-infected people cannot completely avoid exposure. Some guidelines recommend that HIV-infected people receive antifungal prophylaxis if they live in a geographic area where the incidence of fungal infections is very high.

* Source: Centers for Disease Control (CDC)

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