Cryptococcal meningitis

ABSTRACT

Fungal meningitis is a well known problem in immunocompromised patients, after organ transplant, in malignancies and in diabetic or HIV-positive patients. However, cryptococcal meningitis also occurs in immunocompetent persons. Cryptocaccus is the most common cause of fungal meningitis causing a high rote of mortality. The clinical symptoms of cryptococcol meningitis usually are very diverse, nonspecific often chronic and often complicated. Symptoms can be neuropsychiatric [e.g., delirium or mania] [especially in the beginning], purely a meningeal syndrome, or a brood spectrum of focal neurological deficits and symptoms of raised intracranial pressure. Cerebrospinal fluid in cryptococcal meningitis typically reveals mononuclear pleocytosis with varying polymarphonuclear leukocytes, increase in protein and often decrease in glucose. A positive culture is the gold standard for diagnosis. Culture, India ink stain and antigen testing are usually positive in immunocompromised patients. These tests need enough fungal yield in order to become positive and thus may be negative [in varying percentages] in immunocompetent patients. The gold standard for therapy are amphothericin B [0.7- 1 mg/kg/day] and flucytosine [100 mg/kg/day] for the first 2 weeks. For the next 8 weeks, treatment is switched to fluconazole [400 mg/day]. Thereafter, fluconazole is continued at the dose of 200 mg/day for 6 - 12 months depending on the immune status of the patient. In summary, cryptococcal meningitis and meningoencephalitis have to be considered also in immunocompetent patients especially in atypical clinical presentations and in chronic meningitis. This report highlights the peculiarities of the clinical presentation, diagnosis and management of fungal meningitis and particularly of cryptococcal meningitis