Meningitis is when the membranes that surround the brain and spinal cord, called the meninges, become inflamed. Bacteria or viruses often cause it, although fungi can cause it too.
Fungal meningitis is rare. It isn't contagious. Several species of fungi can cause fungal meningitis. One of the most common is the Cryptococcus species.
Continue reading to discover more about the causes, symptoms, and treatment of fungal meningitis.
Fungal meningitis is rare. It typically develops when a fungal infection spreads through the blood to the spinal cord.
Anyone can develop fungal meningitis. People with a weakened immune system are more at risk.
Examples of things that can weaken your immune system include:
- medications that affect the immune system, including corticosteroids such as prednisone, cancer treatments, and medications for autoimmune conditions
- medication taken after organ transplants, which causes immunosuppression
- HIV
Fungal spores can be found throughout our environment. When the area they're in gets disrupted or disturbed, they can become airborne and be inhaled. The infection can then spread from the lungs into the bloodstream, where it can then reach the spinal cord.
There are several different species of fungi that can cause meningitis. In addition to causing fungal meningitis, these fungi can also cause infections of the lungs and other parts of the body.
Cryptococcus
Cryptococcus species can be found widely throughout the world. They can be located in soil that's contaminated with bird droppings as well as in tree hollows and decaying wood.
The Centers for Disease Control and Prevention (CDC) reports there are around 0.4 to 1.3 cases of cryptococcal infection per 100,000 people in the United States each year. The chance of death is 12 percent. Outside of the United States cryptococcal infections can be much more serious.
Cryptococcus infection is a major cause of illness in people with HIV and AIDS. The CDC estimates 220,000 cases of cryptococcal meningitis occur worldwide in this population each year and cause 181,000 deaths.
Histoplasma
Histoplasma can be found in soil and areas that have a high amount of bird or bat droppings. It can be found throughout the world. In the United States it's primarily found in the southeastern states as well as the Mississippi and Ohio River valleys.
It's thought that the rate of Histoplasma infection in adults 65 and older is 3.4 cases per 100,000 people in the United States. The CDC estimates that the chance of death from Histoplasma infection is about 8 percent for adults and 5 percent in children. It may be higher when the nervous system is involved.
Blastomyces
Blastomyces fungus is also soil-based. It's found in the United States in regions such as the southeastern states, Great Lakes region, and the Mississippi and Ohio River valleys.
In areas of the country where Blastomyces infection is reportable, the CDC estimates that each year there are about one to two cases per 100,000 people. Death from a Blastomyces infection is rare. Just over 1,000 deaths have been reported between 1990 and 2010 in the United States.
Coccidioides
Coccidioides lives in dry soil with a high salt content. It's found in the southwestern United States, including:
- New Mexico
- Arizona
- Nevada
- Utah
- California
According to the CDC, there were more than 14,000 reported cases of Coccidioides infection in the United States in 2017. Between the years 1999 and 2016, there were about 200 deaths related to Coccidioides infection each year.
Meningitis due to Coccidioides infection is fatal if it isn't treated. The death rate is about 30 percent with treatment.
Candida
Candida species can also cause fungal meningitis. It's typically acquired in a hospital setting as opposed to out in the environment.
The death rate of Candida-associated meningitis can vary between 10 and 30 percent, depending on whether the individual is in an at-risk group or not. People who are immunocompromised or have had neurological procedures are more at risk.
Although they're similar to other types of meningitis, the symptoms of fungal meningitis typically come on gradually as opposed to suddenly. Some symptoms to look out for include:
- fever
- headache
- nausea or vomiting
- stiff neck
- sensitivity to light
- confusion or hallucinations
Although rash can be a symptom of some cases of meningitis, rash associated with fungal meningitis (caused by Cryptococcus species) has been reported only rarely.
In order to diagnose fungal meningitis, your doctor will first take your medical history and perform a physical examination. If they suspect meningitis, they'll perform tests to determine the specific cause.
Determining the exact cause is important not only because of the seriousness of meningitis, but also because what's causing your condition will determine the treatment.
Some additional tests your doctor may perform include:
Blood tests
Your doctor will take a sample of blood from a vein in your arm. The sample will then be sent to a lab to see if fungi can be detected.
Cerebrospinal fluid (CSF) tests
Also called a spinal tap or lumbar puncture, this procedure collects a sample of CSF. This is the fluid that surrounds and protects your brain and spinal cord.
During the procedure, a needle is inserted between the vertebrae in your lower back to collect the sample.
The CSF will then be sent to a lab for testing. People with meningitis often have CSF samples with abnormal levels of white blood cells, protein, and glucose.
Additionally, the sample can be further tested to determine what type of microorganism may be causing your condition.
Imaging tests
Your doctor may choose to use a CT or MRI scan to visualize swelling or inflammation around your brain.
Fungal meningitis is treated with a long course of high doses of antifungal medication. These medications are often given intravenously (via IV) in the hospital.
Depending on the situation, treatment for fungal meningitis can last for several weeks or up to six months and even longer. Some people, such as those with HIV and cryptococcus meningitis, may need lifelong suppressive therapy after the initial treatment.
The total length of treatment can depend on how strong a person's immune system is. People with a weakened immune system may require a longer course of treatment.
Additionally, the type of fungi that's causing the meningitis can also affect the length of treatment as well as the type of antifungal medication that's used.
Some examples of antifungal medications that may be used to treat fungal meningitis include:
- amphotericin B
- fluconazole
- flucytosine
- itraconazole
In some cases, one antifungal medication may be used. In other cases, you may take a combination. For example, treatment of cryptococcal meningitis involves an initial treatment with amphotericin B and flucytosine, followed by fluconazole treatment.
Fungal meningitis is rare. According to a 2008 report, viruses and bacteria made up the most hospitalizations due to meningitis in 2006. Fungi and other microbes accounted for just over 7 percent of meningitis hospitalizations.
Like any kind of meningitis, fungal meningitis can become serious and even fatal if it isn't properly identified and treated. Complications such as brain damage and seizures can occur.
Death due to fungal meningitis can vary greatly depending on the fungus that's causing the infection as well as a person's immune status. People with a weakened immune system may have a harder time fighting the infection.
One study found that death within one year due to cryptococcal meningitis was 13 percent in a group of people who didn't have HIV but 78 percent in a group of people who had HIV in Malawi.
With proper diagnosis and treatment, the outlook is good. Treatment and recovery often can require long-term use of antifungal medications for six months or longer.
It can be difficult to avoid coming into contact with fungi since they're present throughout our environment. Additionally, there aren't any particular activities that are known to lead to fungal meningitis.
To prevent fungal meningitis, try to avoid soil or other environments likely to contain fungus, such as areas with rotting vegetation or places contaminated with the droppings of birds or bats. This is particularly important for individuals with weakened immune systems.
Additionally, people with a weakened immune system may wish to avoid activities that involve coming into contact with dust or soil.
Some areas of the United States, such as the Ohio and Mississippi River valleys, are home to species of fungi that can cause fungal meningitis. Extra care should be taken when visiting these regions.
Regardless of the suspected cause, always seek immediate medical attention if you're experiencing the symptoms of meningitis. Meningitis is a serious disease. If treatment is delayed, there's a risk of serious complications or death.
Meningitis is inflammation of the tissues that surround the brain and spinal cord. Although fungi can cause meningitis, this is very rare.
A variety of species of fungi can cause fungal meningitis. Treatment will depend on the type of fungi that's causing the condition as well as a person's immune status.
If you're experiencing the symptoms of meningitis, see your doctor as soon as possible. Meningitis can become very serious and possibly fatal if it isn't treated in a timely manner.