Fungal meningitis risk factors

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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 rarely occurs in otherwise healthy individuals. Co-existing medical conditions, immunosuppression and travel history to areas where specific fungi are endemic are risk factors for fungal meningitis. ^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]

Risk Factors

Risk factors in the development of fungal meningitis include:^[9]^[10]^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[11]

Risk factors by the causative organism

Aspergillus sp.
Blastomyces dermatitidis
- Travel to or residence in midwestern and southeastern USA
- Systemic infection
- Abscesses
- Draining sinus
- Ulcers
Coccidioides immitis
- Exposure history
- Travel to or residence in southwestern United States
- Dark-skinned races
- Elderly individuals
- Income of < $15,000 per year
- Pregnancy
- Persons with diabetes and
- Smoking
Candida sp.
- IV drug abuse
- Post surgery
- Prolonged intravenous therapy
- Disseminated candidiasis
Cryptococcus neoformans
- Human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS)
- Immune suppression (examples systemic neoplasia and organ transplantation)
- Pigeon exposure
- Skin and other organ involvement due to disseminated infection
Histoplasma capsulatum
- Exposure history
- Travel to or residence in Ohio and central Mississippi River Valley
- Human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS)
- Mucosal lesions
Pseudallescheria boydii
- Water aspiration
Sporothrix schenckii
- Traumatic inoculation
- IV drug use
- Ulcerated skin lesion^[12]

Risk factors in children

Children with the following conditions have higher incidence of fungal meningitis:

Myeloperoxidase deficiency^[13]^[14]

Chronic granulomatous disease of childhood^[15]^[16]

Chronic mucocutaneous candidiasis^[17]

White blood cell defects^[15]^[16]

Severe combined immunodeficiency SCID^[18]

Advanced HIV^[19]

Direct extension via trauma ^[20]

Post ventriculostomy placement, or ventricular shunts, especially after antibacterial therapy^[21]^[22]

Use of bischloroethylnitrosourea polymer wafers implanted for local therapy of CNS malignancies^[23]^[24]

CNS drains and catheters represent disease^[25]

In premature infants and neonates^[26]

References

↑ ^1.0 ^1.1 Chiller TM, Galgiani JN, Stevens DA (2003). "Coccidioidomycosis". Infect Dis Clin North Am. 17 (1): 41–57, viii. PMID 12751260.
↑ ^2.0 ^2.1 Singh N, Husain S (2000). "Infections of the central nervous system in transplant recipients". Transpl Infect Dis. 2 (3): 101–11. PMID 11429020.
↑ ^3.0 ^3.1 Rosenstein NE, Emery KW, Werner SB, Kao A, Johnson R, Rogers D; et al. (2001). "Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995-1996". Clin Infect Dis. 32 (5): 708–15. doi:10.1086/319203. PMID 11229838.
↑ ^4.0 ^4.1 Gottfredsson M, Perfect JR (2000). "Fungal meningitis". Semin Neurol. 20 (3): 307–22. doi:10.1055/s-2000-9394. PMID 11051295.
↑ ^5.0 ^5.1 Fraser DW, Ward JI, Ajello L, Plikaytis BD (1979). "Aspergillosis and other systemic mycoses. The growing problem". JAMA. 242 (15): 1631–5. PMID 480580.
↑ ^6.0 ^6.1 Perfect JR, Lang SD, Durack DT (1980). "Chronic cryptococcal meningitis: a new experimental model in rabbits". Am J Pathol. 101 (1): 177–94. PMC 1903580. PMID 7004196.
↑ ^7.0 ^7.1 Perfect JR, Durack DT (1985). "Chemotactic activity of cerebrospinal fluid in experimental cryptococcal meningitis". Sabouraudia. 23 (1): 37–45. PMID 3992427.
↑ ^8.0 ^8.1 Perfect JR, Durack DT (1985). "Effects of cyclosporine in experimental cryptococcal meningitis". Infect Immun. 50 (1): 22–6. PMC 262129. PMID 3899932.
↑ Morgand M, Rammaert B, Poirée S, Bougnoux ME, Tran H, Kania R; et al. (2015). "Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole". Antimicrob Agents Chemother. 59 (12): 7857–61. doi:10.1128/AAC.01506-15. PMC 4649149. PMID 26392507.
↑ Shankar SK, Mahadevan A, Sundaram C, Sarkar C, Chacko G, Lanjewar DN; et al. (2007). "Pathobiology of fungal infections of the central nervous system with special reference to the Indian scenario". Neurol India. 55 (3): 198–215. PMID 17921648.
↑ Mody CH, Toews GB, Lipscomb MF (1988). "Cyclosporin A inhibits the growth of Cryptococcus neoformans in a murine model". Infect Immun. 56 (1): 7–12. PMC 259224. PMID 3275587.
↑ Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.
↑ Oleske J, Minnefor A, Cooper R, Thomas K, dela Cruz A, Ahdieh H; et al. (1983). "Immune deficiency syndrome in children". JAMA. 249 (17): 2345–9. PMID 6834633.
↑ Ludviksson BR, Thorarensen O, Gudnason T, Halldorsson S (1993). "Candida albicans meningitis in a child with myeloperoxidase deficiency". Pediatr Infect Dis J. 12 (2): 162–4. PMID 8381226.
↑ ^15.0 ^15.1 Cohen MS, Isturiz RE, Malech HL, Root RK, Wilfert CM, Gutman L; et al. (1981). "Fungal infection in chronic granulomatous disease. The importance of the phagocyte in defense against fungi". Am J Med. 71 (1): 59–66. PMID 7195647.
↑ ^16.0 ^16.1 Fleischmann J, Church JA, Lehrer RI (1986). "Primary Candida meningitis and chronic granulomatous disease". Am J Med Sci. 291 (5): 334–41. PMID 3706396.
↑ Germain M, Gourdeau M, Hébert J (1994). "Case report: familial chronic mucocutaneous candidiasis complicated by deep candida infection". Am J Med Sci. 307 (4): 282–3. PMID 8160723.
↑ Smego RA, Devoe PW, Sampson HA, Perfect JR, Wilfert CM, Buckley RH (1984). "Candida meningitis in two children with severe combined immunodeficiency". J Pediatr. 104 (6): 902–4. PMID 6726524.
↑ Casado JL, Quereda C, Oliva J, Navas E, Moreno A, Pintado V; et al. (1997). "Candidal meningitis in HIV-infected patients: analysis of 14 cases". Clin Infect Dis. 25 (3): 673–6. PMID 9314460.
↑ Brenier-Pinchart MP, Leclercq P, Mallié M, Bettega G (1999). "Candida meningitis possibly resulting from a harpoon injury". Eur J Clin Microbiol Infect Dis. 18 (6): 454–5. PMID 10442428.
↑ O'Brien D, Stevens NT, Lim CH, O'Brien DF, Smyth E, Fitzpatrick F; et al. (2011). "Candida infection of the central nervous system following neurosurgery: a 12-year review". Acta Neurochir (Wien). 153 (6): 1347–50. doi:10.1007/s00701-011-0990-9. PMID 21431456.
↑ Nguyen MH, Yu VL (1995). "Meningitis caused by Candida species: an emerging problem in neurosurgical patients". Clin Infect Dis. 21 (2): 323–7. PMID 8562739.
↑ O'Brien D, Cotter M, Lim CH, Sattar MT, Smyth E, Fitzpatrick F (2011). "Candida parapsilosis meningitis associated with Gliadel (BCNU) wafer implants". Br J Neurosurg. 25 (2): 289–91. doi:10.3109/02688697.2010.534202. PMID 21158511.
↑ Glick JA, Graham RS, Voils SA (2010). "Candida meningitis post Gliadel wafer placement successfully treated with intrathecal and intravenous amphotericin B." Ann Pharmacother. 44 (1): 215–8. doi:10.1345/aph.1M453. PMID 20028954.
↑ Geers TA, Gordon SM (1999). "Clinical significance of Candida species isolated from cerebrospinal fluid following neurosurgery". Clin Infect Dis. 28 (5): 1139–47. doi:10.1086/514755. PMID 10452649.
↑ Fernandez M, Moylett EH, Noyola DE, Baker CJ (2000). "Candidal meningitis in neonates: a 10-year review". Clin Infect Dis. 31 (2): 458–63. doi:10.1086/313973. PMID 10987705.

Template:WH Template:WS

[pmid12751260-1] 1.0 ^1.1 Chiller TM, Galgiani JN, Stevens DA (2003). "Coccidioidomycosis". Infect Dis Clin North Am. 17 (1): 41–57, viii. PMID 12751260.

[pmid11429020-2] 2.0 ^2.1 Singh N, Husain S (2000). "Infections of the central nervous system in transplant recipients". Transpl Infect Dis. 2 (3): 101–11. PMID 11429020.

[pmid11229838-3] 3.0 ^3.1 Rosenstein NE, Emery KW, Werner SB, Kao A, Johnson R, Rogers D; et al. (2001). "Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995-1996". Clin Infect Dis. 32 (5): 708–15. doi:10.1086/319203. PMID 11229838.

[pmid11051295-4] 4.0 ^4.1 Gottfredsson M, Perfect JR (2000). "Fungal meningitis". Semin Neurol. 20 (3): 307–22. doi:10.1055/s-2000-9394. PMID 11051295.

[pmid480580-5] 5.0 ^5.1 Fraser DW, Ward JI, Ajello L, Plikaytis BD (1979). "Aspergillosis and other systemic mycoses. The growing problem". JAMA. 242 (15): 1631–5. PMID 480580.

[pmid7004196-6] 6.0 ^6.1 Perfect JR, Lang SD, Durack DT (1980). "Chronic cryptococcal meningitis: a new experimental model in rabbits". Am J Pathol. 101 (1): 177–94. PMC 1903580. PMID 7004196.

[pmid3992427-7] 7.0 ^7.1 Perfect JR, Durack DT (1985). "Chemotactic activity of cerebrospinal fluid in experimental cryptococcal meningitis". Sabouraudia. 23 (1): 37–45. PMID 3992427.

[pmid3899932-8] 8.0 ^8.1 Perfect JR, Durack DT (1985). "Effects of cyclosporine in experimental cryptococcal meningitis". Infect Immun. 50 (1): 22–6. PMC 262129. PMID 3899932.

[pmid26392507-9] Morgand M, Rammaert B, Poirée S, Bougnoux ME, Tran H, Kania R; et al. (2015). "Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole". Antimicrob Agents Chemother. 59 (12): 7857–61. doi:10.1128/AAC.01506-15. PMC 4649149. PMID 26392507.

[pmid17921648-10] Shankar SK, Mahadevan A, Sundaram C, Sarkar C, Chacko G, Lanjewar DN; et al. (2007). "Pathobiology of fungal infections of the central nervous system with special reference to the Indian scenario". Neurol India. 55 (3): 198–215. PMID 17921648.

[pmid3275587-11] Mody CH, Toews GB, Lipscomb MF (1988). "Cyclosporin A inhibits the growth of Cryptococcus neoformans in a murine model". Infect Immun. 56 (1): 7–12. PMC 259224. PMID 3275587.

[12] Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.

[pmid6834633-13] Oleske J, Minnefor A, Cooper R, Thomas K, dela Cruz A, Ahdieh H; et al. (1983). "Immune deficiency syndrome in children". JAMA. 249 (17): 2345–9. PMID 6834633.

[pmid8381226-14] Ludviksson BR, Thorarensen O, Gudnason T, Halldorsson S (1993). "Candida albicans meningitis in a child with myeloperoxidase deficiency". Pediatr Infect Dis J. 12 (2): 162–4. PMID 8381226.

[pmid7195647-15] 15.0 ^15.1 Cohen MS, Isturiz RE, Malech HL, Root RK, Wilfert CM, Gutman L; et al. (1981). "Fungal infection in chronic granulomatous disease. The importance of the phagocyte in defense against fungi". Am J Med. 71 (1): 59–66. PMID 7195647.

[pmid3706396-16] 16.0 ^16.1 Fleischmann J, Church JA, Lehrer RI (1986). "Primary Candida meningitis and chronic granulomatous disease". Am J Med Sci. 291 (5): 334–41. PMID 3706396.

[pmid8160723-17] Germain M, Gourdeau M, Hébert J (1994). "Case report: familial chronic mucocutaneous candidiasis complicated by deep candida infection". Am J Med Sci. 307 (4): 282–3. PMID 8160723.

[pmid6726524-18] Smego RA, Devoe PW, Sampson HA, Perfect JR, Wilfert CM, Buckley RH (1984). "Candida meningitis in two children with severe combined immunodeficiency". J Pediatr. 104 (6): 902–4. PMID 6726524.

[pmid9314460-19] Casado JL, Quereda C, Oliva J, Navas E, Moreno A, Pintado V; et al. (1997). "Candidal meningitis in HIV-infected patients: analysis of 14 cases". Clin Infect Dis. 25 (3): 673–6. PMID 9314460.

[pmid10442428-20] Brenier-Pinchart MP, Leclercq P, Mallié M, Bettega G (1999). "Candida meningitis possibly resulting from a harpoon injury". Eur J Clin Microbiol Infect Dis. 18 (6): 454–5. PMID 10442428.

[pmid21431456-21] O'Brien D, Stevens NT, Lim CH, O'Brien DF, Smyth E, Fitzpatrick F; et al. (2011). "Candida infection of the central nervous system following neurosurgery: a 12-year review". Acta Neurochir (Wien). 153 (6): 1347–50. doi:10.1007/s00701-011-0990-9. PMID 21431456.

[pmid8562739-22] Nguyen MH, Yu VL (1995). "Meningitis caused by Candida species: an emerging problem in neurosurgical patients". Clin Infect Dis. 21 (2): 323–7. PMID 8562739.

[pmid21158511-23] O'Brien D, Cotter M, Lim CH, Sattar MT, Smyth E, Fitzpatrick F (2011). "Candida parapsilosis meningitis associated with Gliadel (BCNU) wafer implants". Br J Neurosurg. 25 (2): 289–91. doi:10.3109/02688697.2010.534202. PMID 21158511.

[pmid20028954-24] Glick JA, Graham RS, Voils SA (2010). "Candida meningitis post Gliadel wafer placement successfully treated with intrathecal and intravenous amphotericin B." Ann Pharmacother. 44 (1): 215–8. doi:10.1345/aph.1M453. PMID 20028954.

[pmid10452649-25] Geers TA, Gordon SM (1999). "Clinical significance of Candida species isolated from cerebrospinal fluid following neurosurgery". Clin Infect Dis. 28 (5): 1139–47. doi:10.1086/514755. PMID 10452649.

[pmid10987705-26] Fernandez M, Moylett EH, Noyola DE, Baker CJ (2000). "Candidal meningitis in neonates: a 10-year review". Clin Infect Dis. 31 (2): 458–63. doi:10.1086/313973. PMID 10987705.

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