Fungal meningitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby; Prince Tano Djan, BSc, MBChB [2]
Overview
Fungal meningitis usually presents with progressive symptoms of headache, low grade fever and fatigue. If left untreated, neurological complications might occur.
Natural History, Complications and Prognosis
Natural History
Fungal meningitis is rarely found in immunocompetent patients. It usually occurs in patients with immunosuppression like patients with HIV and transplant patients on immunosuppression and long term steroid therapy. The onset of symptoms is progressive and the course of the infection is protracted. The patients tend to present with symptoms like headache, low grade fever, fatigue and even weight loss[1]. This obscure presentation might cause delay in the diagnosis and in the initiation of the appropriate treatment.
Complications
- Abscesses
- Bone invasion
- Fluid collections
- Neurological deficits
- Ocular invasion
- Papilledema
- Seizures[1]
Prognosis
The mortality associated with fungal meningitis is high. Better prognosis is associated with early diagnosis, early initiation of the treatment and compliance of patients with medications.
Prognosis of cryptococcal meningitis
Prior to the introduction of amphotericin B therapy, cryptococcal meningitis was almost always fatal. Now, although most of these patients can be cured with course of intravenous amphotericin B, the optimum duration of therapy is often unclear, and there is still a significant percentage of early deaths and late treatment failures.
Increasing levels of the following worsens the prognosis of HIV-negative cryptococcal meningitis patients with acute/subacute onset
- Ratio of CSF glucose/blood glucose
- Impaired consciousness and
- Hospitalization length