Meningitis, Fungal

Research output: Chapter in Book/Report/Conference proceedingChapter


Fungal meningitis is usually secondary to infection elsewhere in the body; commonly, there is a primary pulmonary focus of infection. Contiguous infection in the cranial bones or sinuses may also be the primary source of infection for fungal meningitis. Fungi may be directly inoculated into the central nervous system through neurosurgical procedures or can cause meningitis as a complication of epidural steroid injections. The typical clinical presentation of fungal meningitis is headache and low-grade fever that develop over 1 or 2 weeks or longer. The characteristic cerebrospinal fluid (CSF) abnormalities are mononuclear or lymphocytic pleocytosis, increased protein concentration, and decreased glucose concentration. Microscopy and culture of CSF are often negative in fungal meningitis. To increase the yield of a positive fungal culture, large volumes of CSF (approximately 10-15. ml) should be cultured on at least three occasions. CSF obtained by high cervical puncture has a higher yield for positive fungal culture than CSF obtained by lumbar puncture. The CSF cryptococcal polysaccharide antigen test is a highly sensitive and specific test for cryptococcal meningitis, and the CSF complement fixation antibody titer is sensitive and specific for coccidioidal meningitis. The treatment of fungal meningitis is determined by the specific fungus and is different for each fungus. The most common complication of fungal meningitis is hydrocephalus. Patients who develop hydrocephalus need a CSF diversion device. Shunts can be placed in patients receiving antifungal therapy. A ventriculostomy can be used until CSF fungal cultures are sterile, and then the ventriculostomy is replaced by a ventriculoperitoneal shunt.

Original languageEnglish (US)
Title of host publicationEncyclopedia of the Neurological Sciences
PublisherElsevier Inc.
Number of pages3
ISBN (Electronic)9780123851574
ISBN (Print)9780123851581
StatePublished - Jan 1 2014


  • Candida albicans
  • Coccidioides immitis
  • Cryptococcus neoformans
  • Exserohilum rostratum
  • Fungal meningitis
  • Histoplasma capsulatum

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Roos, K. (2014). Meningitis, Fungal. In Encyclopedia of the Neurological Sciences (pp. 1074-1076). Elsevier Inc..