What Is Fungal Meningitis?

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Fungal meningitis is an inflammation and infection of the meninges—membranes that surround the brain and spinal cord. There are different types of meningitis, including viral, bacterial, and fungal. Of these, fungal is the rarest in the United States. Fungal meningitis occurs when a fungus that has entered another area of the body moves to the brain or spinal cord. 

Different types of fungi can cause fungal meningitis. No matter which fungus causes your meningitis, you’ll need to seek medical treatment, which usually involves a long course of antifungal medications. As with all meningitis, fungal meningitis is a serious condition and you should not delay treatment. 

Here’s what you should know about fungal meningitis. 

fungal menigitis

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Types

Fungal meningitis is divided into types, based on the type of fungus that is causing the infection. There are five types of fungal meningitis. 

Cryptococcus Neoformans

Cryptococcus neoformans is a type of fungus that is found around the world in:

  • Soil
  • Bird droppings
  • Rotting wood

People can breathe in the fungus after they’ve been in close contact with soil or other materials that contain it, but most people who are exposed to Cryptococcus neoformans never get sick.

Despite that, this is the most common form of fungal meningitis, accounting for more than 70% of fungal meningitis cases.

People who have weakened immune systems are most likely to have a Cryptococcus neoformans infection, which can present as a lung infection or meningitis, depending on where in the body the infection takes hold. Cryptococcus neoformans infections are particularly common in people who have advanced HIV/AIDS

Coccidioides 

Coccidioides is a fungus found in the soil of the southwestern United States, the State of Washington, Mexico, South America, and Central America. Coccidioides causes a condition called valley fever, or coccidioidomycosis.

Valley fever can occur in anyone and can take months to resolve. People with weakened immune systems are more likely to have severe cases, which can include meningitis.

Coccidioides is responsible for about 16% of fungal meningitis cases.

Candida

Candida, more commonly known as yeast, is a fungus that occurs naturally in the body but can cause infection if it grows too rapidly or enters an area of the body that it shouldn’t—like the meninges.

Some yeast infections—like a vaginal yeast infection or thrush—are contained to one area of the body, but forms of yeast infections, or candidiasis, can be invasive. Invasive candidiasis can permeate the blood system and cause symptoms throughout the body.

About 8% of fungal meningitis cases are linked to candida.

Histoplasma

Histoplasma is a fungus that is found in bird and bat droppings, particularly in the Ohio and Mississippi River valleys, although the fungus can be found well outside that area. Histoplasma causes an infection called histoplasmosis, which can include meningitis. 

Anyone can develop histoplasmosis, and in most cases the condition will resolve on its own. However, people with suppressed immune systems are more likely to experience severe cases, including meningitis. About 6% of fungal meningitis cases are caused by Histoplasma.

Blastomyces

Blastomyces is a fungus found in decomposing leaves and wood, and in moist soil, particularly in the Mississippi River Valley, Ohio River Valley, and Great Lakes regions of the United States.

Blastomyces can cause an infection called blastomycosis. In most cases, there are no symptoms. However, this type of fungal meningitis is rare.

Symptoms

The symptoms of fungal meningitis are the same as general symptoms of meningitis. These include fever, headache, and a stiff neck, especially when they occur altogether. However, your fever may be lower than 100 F, making it difficult to notice. 

Other common symptoms of meningitis include:

  • Aches and pains
  • Fatigue, sleepiness, and trouble waking
  • Lack of appetite
  • Nausea and vomiting
  • Irritability and mood changes 

In some cases, people with meningitis will experience confusion.

Causes

Fungal meningitis occurs when a person is exposed to a fungus (normally by breathing it in), which then causes an infection in the body. Living in areas that are prone to harmful fungi—like the southwestern United States or the Mississippi River Valley—can increase your risk of contracting fungal meningitis. However, the people most at risk are those with underlying health conditions or a weakened immune system.

Risk Factors

People with a weakened immune system are more likely to experience fungal meningitis, as mentioned above. A weakened immune system can occur because of:


Premature babies are also at higher risk for fungal infections, particularly from candida

Diagnosis

In order to diagnose meningitis, your doctor will ask you about your symptoms and history. If they suspect meningitis, they will most likely order blood tests and a spinal tap, in which cerebrospinal fluid is removed from your spine. 

Using these samples, your doctor will be able to identify the cause of your infection. This is particularly important in the case of fungal meningitis since the type of fungus you’ve been exposed to will dictate the course of treatment.

Treatment

In order to treat fungal infections of the nervous system—including fungal meningitis—your doctor will use antifungal medications. Antifungal medications are usually given through an IV at the hospital and continued orally after that. The medications used to treat fungal meningitis include:

  • Amphotericin B
  • Fluconazole 

Prevention

Fungal meningitis is very rare, and there is no need for most people to take precautionary measures. However, if you live in an area that has a higher rate of fungal infection—like the Southwestern United States or the Mississippi River Valley—and you have a compromised immune system, you might consider taking precautions.

These can include:

  • Avoiding bird and bat droppings
  • Avoiding dusty areas
  • Avoiding digging in the soil

If you are at higher risk for fungal infection and live in one of these areas, it’s best to talk to your doctor about what prevention methods make the most sense in your specific case. 

Although there are vaccinations available for bacterial meningitis, neither of the meningitis vaccines protect against fungal meningitis. 

Summary

Fungal meningitis is an inflammation and infection of the meninges—membranes that surround the brain and spinal cord. No matter which fungus causes your meningitis, you’ll need to seek medical treatment, which usually involves a long course of antifungal medications. As with all meningitis, fungal meningitis is a serious condition and you should not delay treatment. 

A Word From Verywell

Fungal meningitis is a rare, but serious condition. If you live in an area where fungal infections are higher and you have a weakened immune system, you can talk to your doctor about the ways to keep yourself safe from fungal meningitis, and fungal infections more broadly. 

If you experience symptoms of meningitis—including the trio of a stiff neck, headache, and fever—it’s important to seek help quickly. The sooner you get treatment, the most likely you are to make a full recovery.

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Article Sources
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  1. Centers for Disease Control and Prevention. C. neoformans Infection. Updated December 29, 2020.

  2. Charalambous, LT. Prevalence, healthcare resource utilization and overall burden of fungal meningitis in the United States. J Medical Microbiology. 2018;67(2):215–227. doi:10.10992Fjmm.0.000656

  3. Centers for Disease Control and Prevention. Valley fever (coccidioidomycosis). Updated December 29, 2020.

  4. Centers for Disease Control and Prevention. Invasive candidiasis. Updated December 29, 2020.

  5. Centers for Disease Control and Prevention. Histoplasmosis. Updated December 29, 2020.

  6. Centers for Disease Control and Prevention. Blastomycosis. Updated December 29, 2010.

  7. Centers for Disease Control and Prevention. Fungal meningitis. Updated August 6, 2019.

  8. MedlinePlus. Meningitis - cryptococcal. Updated December 24, 2020.