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Neurology Week 4 > Fungal Meningitis > Flashcards

Fungal Meningitis Flashcards

1
Q
A
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2
Q

What are some common fungal causes of meningitis?

A

Cryptococcus neoformans

Candida, Aspergillus, Coccidioides, Histoplasma, Blastomyces, Zygomycetes

Exserohilum rostratum

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3
Q

85% of Crytpococcal neoformans meningitis occurs in what patients?

A

HIV pts.

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4
Q

Crytpococcal neoformans is associated with ___________

A

pigeon droppings

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5
Q

What is the structure of Crytpococcal neoformans?

A

Not dimorphic, always an encapsulated yeast

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6
Q

Presentation of Cryptoccocus neoformans

A

Initial pulmonary infection is asymptomatic

Chronic infection leads to meningitis, fatal if left untreated

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7
Q

How is Cryptococcal meningitis diagnosed?

A

get CSF of pt, and treat with India ink, look for halos

or CSF testing for antigens

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8
Q

What is the tx for Cryptococcal meningitis?

A

Amphotericin B and flucytosine combo therapy for CNS cases

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9
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10
Q

Objectives

A
  1. Recall that fungal meningitis is typically an opportunistic infection
  2. Recall the most common cause of fungal meningitis and its key virulence factor
  3. Recall the predominant fungal cause of steroid-linked meningitis
  4. Recall diagnostic and treatment procedures for the discussed forms of meningitis
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11
Q

T or F. Fungal meningitis is rare is typically observed only in immunocompromised pts

A

T.

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12
Q

What is the natural course of Fungal meningitis?

A

Natural course is spread from blood stream to CNS (Recent outbreaks attributable to epidural injection of contaminated steroids are exceptions to natural courses of fungal meningitis)

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13
Q

As with bacterial meningitis, it is critical to quickly suspect and confirm cases. Some ways to do this include:

A
  1. Microscopic observation of yeast forms in CSF samples
  2. Culture of CSF for fungi
  3. Antigen detection in CSF for some fungi (Cryptococcus)
  4. Treat with maximum tolerated doses of amphotericin B for extended times, often in combination with flucytosine which enters the CNS better
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14
Q

The Most common agent in immunocompromised patients is:

A

Cryptococcus neoformans

  1. Other fungi include
    a. Candida spp. (mostly nosocomial)
    b. Aspergillus spp.
    c. Coccidioides immitis
    d. Histoplasma capsulatum
    e. Blastomyces dermatiditis (rare)
    f. Zygomycetes spp. (rare)
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15
Q

Cryptococcosis is caused by cryptococcus neoformand or C. gattii

A
  1. C. neoformans found in pigeon droppings, is inhaled
    a. Worldwide distribution
    b. 85% of all cases occur in HIV-infected patients
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16
Q

Where is C. gattii found?

A
  1. C. gattii found in sub-tropical regions, also west coast US
    a. Found on trees
    b. Most infections recorded in Australia
    c. Accounts for most cryptococcal infections of healthy individuals
17
Q

T or F. C. spp. are not dimorphic fungi, instead are always encapsulated yeasts

A

T.

  1. Capsule is polysaccharide and is antiphagocytic and blocks opsonizaton
18
Q

How does cryptooccocal meningitis present?

A

Cryptococcosis is initially an asymptomatic pulmonary infection, but chronic infection leads to meningitis with increased intracranial pressure

19
Q

How is cryptococcal meningitis diagnosed?

A

D. Diagnosis

  1. yeast with halos in India ink-stained CSF of meningitis patients
  2. serologic testing for a capsular polysaccharide antigen

E. Treat Crytococcal meningitis with amphotericin B and flucytosine

20
Q

Steroid-associated fungal meningitis

  1. More than 660 cases so far identified – not linked to immunodeficiency
    a. 40 deaths
    b. 19 states
    c. 140 cases in TN alone
A
  1. Average time to symptoms has been 20 days
    a. Epidural outcomes range from meningitis, abscesses, stroke, to none
    b. Injections in peripheral joints have resulted in no symptoms or exacerbated arthritis
    c. Because infections could be slow to progress, more cases are possible
21
Q

Steroid-associated fungal meningitis

A

B. Linked to a single compounding center in New England

22
Q

The predominant fungal cause of steroid-associated fungal meningitis is:

A

Exserohilum rostratum

  1. Common environmental black mold that rarely causes infection
  2. Not previously linked to meningitis
23
Q

How is steroid-associated fungal meningitis diagnosed?

A
  1. Culture of CSF
  2. Send CSF to CDC for PCR analysis
24
Q

How is steroid-associated fungal meningitis tx?

A
  1. Meningitis patients should be treated with voriconazole IV for 3 months or more
25
Q

How should severe steroid-associated fungal meningitis be tx?

A
  1. Severe cases or non-responders should receive amphotericin B for 3 months or more
  2. Injection recipients who are asymptomatic should be observed only
    a. Consider lumbar puncture
    b. If CSF contains 5 or more WBCs, begin voriconazole IV

Neurology Week 4 (26 decks)

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