Fact Sheet Number 503
CRYPTOCOCCAL MENINGITIS
- WHAT IS CRYPTOCOCCAL MENINGITIS?
- HOW IS MENINGITIS TREATED?
- HOW DO I CHOOSE A TREATMENT FOR MENINGITIS?
- CAN MENINGITIS BE PREVENTED?
- THE BOTTOM LINE
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PrintWHAT IS CRYPTOCOCCAL MENINGITIS?
Cryptococcus is a fungus. It is very common in the soil. It can
get into your body when you breathe in dust. It does not seem
to spread from person to person.
Meningitis is the most common illness caused by Cryptococcus.
Meningitis is an infection of the lining of the spinal cord and
brain. It can cause coma and death. Cryptococcus can also infect
the skin, lungs, or other parts of the body. The risk of cryptococcal
infection is highest when your T-cell
(CD4+) counts are below 100.
The first signs of meningitis include fever, fatigue, a stiff
neck, headache, nausea and vomiting, confusion and vision problems.
The symptoms may come on slowly.
HIV disease or medications can also cause these symptoms. Therefore,
laboratory tests are used to confirm that you have meningitis.
The tests use spinal fluid. Doctors get the fluid by doing
a spinal tap. A needle is inserted in the middle of your back
just above your hips. The needle removes a sample of spinal fluid.
The test is safe and usually not too painful. However, some people
get headaches after a spinal tap that can last a few days.
The spinal fluid can be tested for cryptococcus in two ways.
A “CRAG” test that looks for an antigen (a protein)
produced by cryptococcus. A “culture” is a way to see
if the cryptococcus fungus can be grown from the sample of spinal
fluid. CRAG tests are quick and can produce same-day results.
A culture can take a week or more to show a positive result.
TREATED?
Meningitis is treated with anti-fungal drugs. Some physicians
use fluconazole. It is available in pill form or as an intravenous
drug. Fluconazole is fairly effective, and is generally easy to
tolerate. Other doctors prefer to use a combination of amphotericin
B and flucytosine capsules. Amphotericin B is a very strong drug.
It is given as an injection or a slow intravenous infusion. It
can have serious side effects.
Cryptococcal meningitis usually comes back after the first
time. Repeat cases are reduced if people keep taking antifungal
drugs.
A TREATMENT FOR MENINGITIS?
If you have meningitis, you will be treated with anti-fungal drugs
such as amphotericin B, fluconazole, and flucytosine. Amphotericin
B is the strongest, but it can damage your kidneys. The other
drugs have less serious side effects, but they are less effective
at clearing out the cryptococcus.
If meningitis is diagnosed early enough, it can be treated
without using amphotericin B. The usual treatment, however, is
two weeks of amphotericin B followed by oral fluconazole. The
fluconazole is continued for life. Without it, the meningitis
is likely to come back.
BE PREVENTED?
Taking fluconazole when your T-cell count is below 50 can help
prevent cryptococcal meningitis. But there are several reasons
why most doctors don’t use it:
- Most fungal infections are easy to treat.
- Fluconazole is a very expensive drug.
- Taking fluconazole for a long period of time can lead to
yeast infections (such as thrush,
vaginitis, or severe candida infection of the throat) that are
resistant to fluconazole. These resistant infections can only
be treated with Amphotericin B.
Cryptococcal meningitis occurs most often in people with T-cell
counts below 100. Although antifungal drugs can prevent cryptococcal
meningitis, they are usually not used because of their high cost
and the risk of developing drug-resistant yeast infections.
If you get meningitis, early diagnosis might allow treatment
with less toxic drugs. Contact your physician if you have headaches,
a stiff neck, vision problems, confusion, nausea, or vomiting.
If you develop meningitis, you will have to continue taking
antifungal drugs to prevent the disease from coming back.
Reviewed May 16, 2002
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New Mexico AIDS Education and Training Center
and the New Mexico Department of Health