Cryptococcal Meningitis: Symptoms, Causes and Treatment

Overview

Three layers of a protective membrane known as meninges line the brain and the spinal cord. When there is an infection of the meninges, it is known as meningitis. However, when the infection is due to a fungus called Cryptococcus, it is cryptococcal meningitis. It is a type of meningitis that affects people with a weakened immune system due to other health conditions. Failure to receive timely treatment can have a permanent result and sometimes be fatal. 

The blog discusses cryptococcal meningitis, its symptoms, causes, and various treatment options. 

What is cryptococcal meningitis?

As mentioned above, the brain and the spinal cord are protected with three layers of a membrane known as meninges. But when the cryptococcus fungus infects the meninges, it causes a severe fungal infection in the brain and the spinal cord called cryptococcal meningitis. 

Immune-compromised people are at a higher risk of developing cryptococcal meningitis. 

Who is at risk of developing cryptococcal meningitis?

The fungus mostly affects people with a compromised immune system. Nearly 85% of the reported cryptococcal meningitis cases are among HIV patients. Other health conditions that reduce a person’s immunity are as follows: 

• Blood diseases
• Organ failure syndrome
• Organ transplant receivers, those on immunosuppressant medicines
• Immunodeficiency syndromes
• Various treatments that include steroids and other immunity-reducing medicines
• AIDS or HIV
• Cirrhosis
• Diabetes
• Leukaemia
• Sarcoidosis

What are the causes of cryptococcal meningitis?

There are two types of fungi that result in cryptococcal meningitis. Cryptococcus neoformans causes nearly all cases of cryptococcal meningitis. It is commonly found in soil and spread through bird droppings. Another fungus is the Cryptococcus gatti, located in the soil. It is also found in the debris of several trees, such as the eucalyptus. It is not found in bird droppings. 

Cryptococcal meningitis is not a transmittable disease, meaning it does not spread from one person to another. The fungus forms spores that may be spread in the soil, bird droppings, and decaying wood. When a person inhales these spores, they enter the lungs of a person with a compromised immune system, reach the lymph nodes to multiply into many cells and continue to spread, thus affecting the brain cells. The symptoms gradually appear.

What are the symptoms of cryptococcal meningitis?

Cryptococcal meningitis shows gradual signs over a few days to a few weeks after exposure to the fungus. The following are the symptoms:

• Fever
• Headaches
• Confusion or hallucination
• Changes in mental status
• Nausea and Vomiting
• Sensitivity to light
• Stiff neck
• Fatigue
• Blurred vision and other eye problems
• Loss of hearing

Doctors find it difficult to diagnose cryptococcal meningitis accurately. Most symptoms may be similar to the side effects due to medications for treating the underlying health condition. 

If left untreated, particularly for HIV patients, it can be fatal. According to the British Medical Bulletin, 10 to 30% of HIV patients lose their life due to the illness.

When to seek medical attention?

Contact the doctor if a person is experiencing any of the symptoms. Immediately visit the hospital if a child is exhibiting the following signs:

• Problems in feeding
• High-pitched cry
• Irritability 
• Constant, unexplained fever

Request an appointment at Apollo Hospitals           

How is cryptococcal meningitis diagnosed?

The healthcare provider conducts a physical examination and asks the patient about their symptoms. If the doctor suspects cryptococcal meningitis, they will order the following tests:

• Lumbar puncture: In this procedure, the neurologist inserts a needle to drain a tiny amount of spinal fluid. The fluid is tested for infection. 
• Blood culture test
• Chest X-ray
• CT scan of brain
• CSF culture
• Cryptococcal antigen in CSF or blood

What are the treatment options for cryptococcal meningitis?

Antifungal medicines are known to treat cryptococcal meningitis. However, the treatment takes several months for the patient to cure completely. These medications are administered intravenously. Amphotericin B is the most common treatment option that is typically combined with an oral antifungal medication called 5-flucytosine. The doctor carefully monitors the patient for side effects like kidney damage.

During the treatment, the patient has to undergo a lumbar puncture every two weeks to check for the illness. If the results are negative for two consecutive weeks, the patient is cured of cryptococcal meningitis. In such cases, the doctor changes the medication to fluconazole – the patient needs to take medicine for eight weeks.

What are the complications of cryptococcal meningitis?

Recovering cryptococcal meningitis patients need long-term medication to prevent the recurrence of the illness and improve their immune systems. The following are the possible complications:

• Brain damage
• Loss of hearing or vision
• Increase in cerebal spinal fluid in the brain
• Seizures
• Death

The possible side effects of amphotericin B are as follows:

• Vomiting and nausea
• Fever and chills
• Pain in the joints and muscles
• Kidney damage

Conclusion

Cryptococcal meningitis is a life-threatening illness that is caused due to a fungus. It typically affects people with a compromised immune system. With timely medical attention, the patient can completely recover. 

Frequently Asked Questions (FAQs)

Is the illness transmittable?

The illness is not contagious or transmittable. The spores of the fungus need to be inhaled for a person to develop the disease. 

Is cryptococcal meningitis a deadly disease?

If the illness is left untreated, it can be fatal.