Fungal Meningitis

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*Fungal meningitis facts medical author: Charles P. Davis, MD, PhD

• Fungal meningitis is rare; the most common cause is Cryptococcus spp. infection, but many other fungi may occasionally cause meningitis.
• Fungal meningitis is not transmitted from person to person. The fungi are usually inhaled and then spread by the blood to the central nervous system; fungi may also be directly inserted into the central nervous system by medical techniques or enter from an infected site near the central nervous system to cause meningitis.
• Risk factors include any disease or treatment that may weaken the immune system, surgical procedures and medications may introduce fungi into the central nervous system, and other factors such as pregnancy or living in areas that have high fungal concentrations in the soil or air increase the risk of fungal meningitis.
• Headache, stiff neck, fever, nausea and vomiting, photophobia, and altered mental status are potential symptoms of fungal meningitis.
• Blood and cerebrospinal fluid are cultured and examined to diagnose fungal meningitis.
• Treatment of fungal meningitis is with IV antifungal drugs; the length of treatments vary with the patient's immune status.
• Although no specific activities are known to cause fungal meningitis, people with immune system problems are advised to avoid areas and geographical regions where soil, dust, or bird droppings may have high fungal contamination.

Fungal meningitis is rare and usually the result of spread of a fungus through blood to the spinal cord. Although anyone can get fungal meningitis, people with weak immune systems, like those with AIDS or cancer, are at higher risk.

The most common cause of fungal meningitis for people with weak immune systems is Cryptococcus. This disease is one of the most common causes of adult meningitis in Africa.

Fungal meningitis is not contagious, which means it is not transmitted from person to person. Fungal meningitis can develop after a fungus spreads through the bloodstream from somewhere else in the body, as a result of the fungus being introduced directly into the central nervous system, or from an infected body site infection next to the central nervous system.

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.

Different types of fungus are transmitted in several ways. Cryptococcus is thought 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. Blastomyces is thought to exist in soil rich in decaying organic matter in the Midwest United States, particularly the northern Midwest. 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.