Learning about Fungal Meningitis

What is meningitis?

  • Meningitis is a general term for swelling of the protective membranes that cover the brain and spine
  • The swelling is typically caused by an infection of the fluid surrounding the brain and spinal cord that can be caused by bacteria, viruses, parasites or fungus, although meningitis also be caused by injury, cancer or medications
  • There are many different types of meningitis, including bacterial, viral, fungal and parasiti 

What is fungal meningitis?

  • Fungal meningitis is a rare type of meningitis, but it can be life threatening

What are the risk factors for fungal meningitis?

  • Although anyone can get fungal meningitis, people at higher risk include those who have AIDS, leukemia, or other forms of immunodeficiency and immunosuppression
  • People with certain medical conditions like diabetes, cancer, or HIV are at higher risk of fungal meningitis
  • You may also get fungal meningitis after taking medications that weaken your immune system
    • Examples include steroids (such as prednisone), medications given after organ transplantation, or anti-TNF medications, which are sometimes given for treatment of rheumatoid arthritis or other autoimmune conditions
  • Pre-mature babies with very low birth weights are also at increased risk
  • Living in certain areas of the U.S. may increase one’s risk
    • For example, bird/bat droppings in the Midwestern United States and soil in the Southwestern United States are more likely to contain a fungus that can cause meningitis

Transmission

  • Fungal meningitis is not contagious – it is not transmitted from person to person
  • People at risk for fungal meningitis acquire the infection usually by inhaling fungal spores from the environment

Signs & Symptoms

  • Meningitis infection is characterized by a sudden onset of fever, headache, and stiff neck. It is often accompanied by other symptoms, such as:
    • Nausea
    • Vomiting
    • Photophobia (sensitivity to light)
    • Altered mental status
  • Symptoms of fungal meningitis are similar to symptoms of other forms of meningitis; however, they often appear more gradually
  • In addition to typical meningitis symptoms, like headache, fever, nausea, and stiffness of the neck, people with fungal meningitis may also experience:
    • Dislike of bright lights
    • Changes in mental status, confusion
    • Hallucinations
    • Personality changes

Diagnosis

  • If meningitis is suspected, samples of blood or cerebrospinal fluid (near the spinal cord) are collected and sent to the laboratory for testing

Treatment

  • Fungal meningitis is treated with long courses of high dose antifungal medications usually given using an IV line and is done in the hospital
  • The length of treatment depends on the status of the immune system and the type of fungus that caused the infection

Prevention

  • There is little evidence that specific activities can lead to developing fungal meningitis, although avoiding exposure to environments likely to contain fungal elements is prudent
  • People who are immunosuppressed (for example, those with HIV infection) should try to avoid bird droppings and avoid digging and dusty activities, particularly if they live in a geographic region where fungi exist 

Take Home Messages

  • The scope and cause of this outbreak have yet to be determined
    • The infection can take up to 28 days to develop
  • The investigation is ongoing and evolving; they are closer to identifying the cause, but have not concluded there is one factor at this time