Cryptococcal Meningitis Guidelines

Cryptococcal meningitis is a rare fungal form of meningitis most common in people with compromised immune systems. The symptoms closely resemble those of bacterial or viral meningitis and, if not treated promptly, the condition can be fatal. Individuals who fall within the category of people particularly susceptible to cryptococcal meningitis should take care to monitor their health carefully for signs of the condition.

Aspects

• Cryptococcal meningitis is an infection of the meninges--the thin membrane covering the brain and spinal column--by the specific fungus Cryptococcus neoformans. This particular type of fungus is common worldwide in soil. It is often also present in the droppings of some animals, such as birds. When the fungus enters the body of susceptible individuals, it causes inflammation and swelling of the meninges and disrupts the balance of the cerebrospinal fluid. Although Cryptococcus neorformans is widespread, the immune systems of most individuals are able to fight off this fungal infection.

Risks

• Certain groups of people are more likely to suffer from a Cryptococcal neoformans infection. These include people with conditions that weaken their immune systems, such as AIDS, lymphoma, diabetes and certain types of cancer. AIDS or HIV-infected patients with a CD4, or T-cell, count lower than 50 are especially susceptible to cryptococcal meningitis.

Symptoms

• Cryptococcal meningitis symptoms include neck stiffness and the development of a severe headache. The individual will develop a high fever and become extremely sensitive to light. Nausea and vomiting are common. Some afflicted individuals may hallucinate and experience sudden dramatic changes in their mental state.

Treatment

• Cryptococcal meningitis is treated with three main anti-fungal drugs: amphotericin B, fluconazole and flucytosine. While amphotericin B is the most effective at eradicating Cryptococcal neoformans infections, it can cause serious side effects, including kidney damage. Physicians often begin treatment with amphotericin B, then switch to the milder flucytosine. Fluconazole is effective at treating less severe forms of the condition.

Prevention

• Individuals with healthy immune systems rarely contract cryptococcal meningitis. For people whose immune systems are compromised--particularly those with CD4 cell counts lower than 50- the only effective preventive measure is the regular use of fluconazole. Because fluconazole is a highly expensive drug and can cause an increase in fluconazole-resistant infections in people taking it, this is rarely done. The best defense against cryptococcal meningitis is to seek prompt medical attention if you experience any symptoms of the disease. This is especially important for individuals with AID or HIV who are aware that their CD4 cell count is low.