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Neuro > Fungal meningitis > Flashcards

Fungal meningitis Flashcards

1
Q

MCC fungal meningitis

A

Cryptococcus

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2
Q

Nosocomial cause of fungal meningitis

A

Candida

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3
Q

Steroid-associated fungal meningitis

A

Exserohilum rostratum

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4
Q

Route of spread of fungal meningitis

A

Bloodstream –> disseminates –> CNS (think immunocompromised patients)

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5
Q

___% of cryptococcal meningitis occurs in HIV patients

A

85%

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6
Q

Morphology of cryptococcus?

A

NOT dimorphic = never in spore form, always an encapsulated yeast

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7
Q

Describe the disease course of cryptococcal meningitis

A

Inhale yeast —> asymptomatic pulmonary infection –> chronic infection (immunocompromised) —> meningitis

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8
Q

Reservoir of cryptococcus

A

PIGEONS!!

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9
Q

How would you diagnose cryptococcus?

A

India ink stain looking for encapsulated yeast (halos)

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10
Q

Treatment strategy for Cryptococcus?

A

Amphotericin B for systemic infection

Flucytosine to cross BBB, unable to control systemic infection on its own

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11
Q

A more sensitive test for Cryptococcus than india ink staining is:

A

Antigen detection in CSF

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12
Q

How was exserohilum rostratum able to penetrate the CSF?

A

It was administered epidurally

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13
Q

How would you diagnose steroid-associated fungal meningitis?

A

Culture and PCR (CDC only) with history of epidural steroid

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14
Q

A patient who received an epidural steroid injection for RA two weeks ago complains of nuchal rigidity and fever. Treatment?

A

IV voriconazole for 3 months

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15
Q

A patient who received epidural steroid injection for RA two weeks ago is found to have received medication from a batch infected with Exserohilum rostratum. CSF analysis does not show PMNs or fungus. Treatment?

A

Observe patient if asymptomatic

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16
Q

A patient who received epidural steroid injection for RA two weeks ago has a fever of 103, severe neck stiffness, N/V, severe HA, and decreasing consciousness. Treatment?

A

IV amphotericin B for 3 months

17
Q

A patient who received epidural steroid injection for RA two weeks ago is found to have received medication from a batch infected with Exserohilum rostratum. She denies any HA, neck stiffness, fever, N/V. CSF analysis shows 3 PMNs but no fungus. Treatment?

A

IV voriconazole for 3 months

(although patient is asymptomatic, treat if any PMNs are present)

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