Infectious disease and impaired consciouness fungal infection
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?● Whats the medical therapy for Cryptococcal meningitis?● Whats the medical therapy for Coccidioides meningitis?● Whats 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
ReferenceInfectious Disease and Impaired ConsciousnessMichael R. Wilson, MD, Karen L. Roos, MDNeurology Clinics; 2011 Nov;29(4):927-42.