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Fungal Meningitis

          javier benitez (jvrbntz)
             In 5 slides or less...
Case Presentation
●   A young woman w Hx of back pain treated
    with steroid injections p/w decreased level of
    consciousness after two weeks of
    progressively worsening of headache.
●   After a careful history and physical exam
    your working diagnosis is meningitis
●   You decide to perform a lumbar puncture
    and treat the patient for possible fungal
    meningitis
Things to Consider
●   What are the CSF characteristics in fungal meningitis?


●   What's the medical therapy for Cryptococcal
    meningitis?


●   What's the medical therapy for Coccidioides
    meningitis?


●   What's the management of increased intracranial
    pressure?
●
    Fungal meningitis CSF:
         –   Normal/elevated opening pressure
         –   Lymphocytic pleocytosis
         –   Elevated protein concentration
         –   Decreased glucose concentration
         –   Send CSF for fungal culture, india ink, ag detection, C.
               immitis ab fixation test
●   Cryptococcal meningitis therapy: Primary: -Induction:
    amphotericin B + flucytosine -Consolidation: fluconazole
    Maintenance (suppressive): fluconazole
●   Coccidioides immitis: High dose fluconazole or amphotericin B
    (IV or intrathecal)
●
    Increased ICP: If initial pressure is elevated lower by 50% →
    daily lumbar puncture → if not possible → ventriculostomy
Reference

Infectious Disease and Impaired Consciousness
Michael R. Wilson, MD, Karen L. Roos, MD
Neurology Clinics; 2011 Nov;29(4):927-42.

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Infectious disease and impaired consciouness fungal infection

  • 1. Fungal Meningitis javier benitez (jvrbntz) In 5 slides or less...
  • 2. Case Presentation ● A young woman w Hx of back pain treated with steroid injections p/w decreased level of consciousness after two weeks of progressively worsening of headache. ● After a careful history and physical exam your working diagnosis is meningitis ● You decide to perform a lumbar puncture and treat the patient for possible fungal meningitis
  • 3. Things to Consider ● What are the CSF characteristics in fungal meningitis? ● What's the medical therapy for Cryptococcal meningitis? ● What's the medical therapy for Coccidioides meningitis? ● What's the management of increased intracranial pressure?
  • 4. Fungal meningitis CSF: – Normal/elevated opening pressure – Lymphocytic pleocytosis – Elevated protein concentration – Decreased glucose concentration – Send CSF for fungal culture, india ink, ag detection, C. immitis ab fixation test ● Cryptococcal meningitis therapy: Primary: -Induction: amphotericin B + flucytosine -Consolidation: fluconazole Maintenance (suppressive): fluconazole ● Coccidioides immitis: High dose fluconazole or amphotericin B (IV or intrathecal) ● Increased ICP: If initial pressure is elevated lower by 50% → daily lumbar puncture → if not possible → ventriculostomy
  • 5. Reference Infectious Disease and Impaired Consciousness Michael R. Wilson, MD, Karen L. Roos, MD Neurology Clinics; 2011 Nov;29(4):927-42.