Fungal meningitis causes

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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 is initially caused by the inhalation of airborne fungal spores. The pulmonary infection is usually self limiting and can be asymptomatic. The most common cause of fungal infection is cryptococcus neoformans which is usually found in soil and bird excreta.[1] Other common causes of fungal meningitis include; Aspergillus spp., Blastomyces dermatitidis, Coccidioides immitis, Candida spp., Histoplasma capsulatum and Sporothrix schenckii.[2][3][4][5][6] Rarely, fungal meningitis may be caused by Xylohypha (formerly Cladosporium) trichoides, Curvularia, Mucor, Arthrographis kalrae, Pneumocystis jirovecii,[7][8] Cryptococcus albidus,[9], Alternaria spp,[10], Rhodotorula spp, [11] Acremonium spp,[12] Dreschlera spp,[13] Malassezia spp,[14] Scedosporium spp,[15] Arthrographis spp,[16] Blastoschizomyces,[17][18] Paecilomyces,[19][20] Aureobasidium,[21] Clavispora,[22] Ustilago,[23] Exophiala (Wangiella)[24] and Exserohilum[25]

Causes

Life-Threatening Causes

Life-threatening conditions may result in death or permanent disability within 24 hours if left untreated. There are no life-threatening causes of fungal meningitis.

Most common cause

The most common cause of fungal meningitis is:[26][27][5]

Common causes

Common causes of fungal meningitis include:[2][3][4][5][6]


The common causes of fungal meningistis may be classified into two subgroups.

1. Primary fungal pathogens of humans

All of these may cause CNS infections. These group include:

  • Dematiaceous fungi[42]

2. Secondary fungal pathogens of humans

The second group is considered opportunistic, which take advantage of significant immune defects in the host. This group includes:

Less common causes

There are some rare causes of fungal meningitis. Some specific historical feature usually surround the outbreak of rare causes of fungal meningitis. For example, outbreaks of fungal meningitis in 2002 with Exophiala (Wangiella) dermatitidis and more recently in 2012 with Exserohilum rostratum were associated with contamination of compounded corticosteroids with resultant severe complications.[52][53][25]

Some of the rare causes include the following:[54][16][7][8][9]

  • Arthrographis spp[16]

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease Arthrographis kalrae, Aspergillus spp, Blastomyces spp, Candida spp, Cladosporium, Coccidioides immitis, Coccidioidomycosis, Cryptococcus albidus, Cryptococcus gattii infection, Cryptococcus neoformans, Exserohilum, Fungal eye infections, Histoplasma capsulatum, Histoplasmosis, Mucormycosis, Pneumocystis jirovecii, Pseudallescheria boydii (Scedosporium apiospermum), Sporothrix schenckii, Xylohypha (formerly cladosporium), Alternaria spp,[10]Rhodotorula spp, [11] Acremonium spp.,[12] Dreschlera spp,[13] Malassezia spp,[14] Scedosporium spp,[15] Arthrographis spp,[16] Blastoschizomyces,[17][18] Paecilomyces,[19][20] Aureobasidium,[21] Clavispora,[22] Ustilago,[23] Exophiala (Wangiella),[24] Exserohilum,[25]
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabethical Order

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2

References

  1. ↑ 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.
  2. ↑ 2.0 2.1 Chiller TM, Galgiani JN, Stevens DA (2003). "Coccidioidomycosis". Infect Dis Clin North Am. 17 (1): 41–57, viii. PMID 12751260.
  3. ↑ 3.0 3.1 Singh N, Husain S (2000). "Infections of the central nervous system in transplant recipients". Transpl Infect Dis. 2 (3): 101–11. PMID 11429020.
  4. ↑ 4.0 4.1 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.
  5. ↑ 5.0 5.1 5.2 Gottfredsson M, Perfect JR (2000). "Fungal meningitis". Semin Neurol. 20 (3): 307–22. doi:10.1055/s-2000-9394. PMID 11051295.
  6. ↑ 6.0 6.1 del Brutto OH (2000). "[Central nervous system mycotic infections]". Rev Neurol. 30 (5): 447–59. PMID 10775973.
  7. ↑ 7.0 7.1 7.2 Villanueva JL, Cordero E, Caballero-Granado FJ, Regordan C, Becerril B, Pachón J (1997). "Pneumocystis carinii meningoradiculitis in a patient with AIDS". Eur J Clin Microbiol Infect Dis. 16 (12): 940–2. PMID 9495679.
  8. ↑ 8.0 8.1 8.2 Baena Luna MR, Muñoz García J, Grancha Bertolín L, Sanz García M (1998). "[Presence of Pneumocystis carinii in cerebrospinal fluid]". An Med Interna. 15 (5): 265–6. PMID 9629775.
  9. ↑ 9.0 9.1 9.2 Melo JC, Srinivasan S, Scott ML, Raff MJ (1980). "Cryptococcus albidus meningitis". J Infect. 2 (1): 79–82. PMID 7185917.
  10. ↑ 10.0 10.1 10.2 OHASHI Y (1960). "On a rare disease due to Alternaria tenuis Nees (alternariasis)". Tohoku J Exp Med. 72: 78–82. PMID 13730495.
  11. ↑ 11.0 11.1 11.2 Shinde RS, Mantur BG, Patil G, Parande MV, Parande AM (2008). "Meningitis due to Rhodotorula glutinis in an HIV infected patient". Indian J Med Microbiol. 26 (4): 375–7. PMID 18974495.
  12. ↑ 12.0 12.1 12.2 Fincher RM, Fisher JF, Lovell RD, Newman CL, Espinel-Ingroff A, Shadomy HJ (1991). "Infection due to the fungus Acremonium (cephalosporium)". Medicine (Baltimore). 70 (6): 398–409. PMID 1956281.
  13. ↑ 13.0 13.1 13.2 Fuste FJ, Ajello L, Threlkeld R, Henry JE (1973). "Drechslera hawaiiensis: causative agent of a fatal fungal meningo-encephalitis". Sabouraudia. 11 (1): 59–63. PMID 4739938.
  14. ↑ 14.0 14.1 14.2 Rosales CM, Jackson MA, Zwick D (2004). "Malassezia furfur meningitis associated with total parenteral nutrition subdural effusion". Pediatr Dev Pathol. 7 (1): 86–90. doi:10.1007/s10024-003-4030-5. PMID 15255040.
  15. ↑ 15.0 15.1 15.2 Symoens F, Knoop C, Schrooyen M, Denis O, Estenne M, Nolard N; et al. (2006). "Disseminated Scedosporium apiospermum infection in a cystic fibrosis patient after double-lung transplantation". J Heart Lung Transplant. 25 (5): 603–7. doi:10.1016/j.healun.2005.12.011. PMID 16678041.
  16. ↑ 16.0 16.1 16.2 16.3 Chin-Hong PV, Sutton DA, Roemer M, Jacobson MA, Aberg JA (2001). "Invasive fungal sinusitis and meningitis due to Arthrographis kalrae in a patient with AIDS". J Clin Microbiol. 39 (2): 804–7. doi:10.1128/JCM.39.2.804-807.2001. PMC 87827. PMID 11158158.
  17. ↑ 17.0 17.1 17.2 Girmenia C, Micozzi A, Venditti M, Meloni G, Iori AP, Bastianello S; et al. (1991). "Fluconazole treatment of Blastoschizomyces capitatus meningitis in an allogeneic bone marrow recipient". Eur J Clin Microbiol Infect Dis. 10 (9): 752–6. PMID 1810730.
  18. ↑ 18.0 18.1 18.2 Naficy AB, Murray HW (1990). "Isolated meningitis caused by Blastoschizomyces capitatus". J Infect Dis. 161 (5): 1041–2. PMID 2324536.
  19. ↑ 19.0 19.1 19.2 Kantarcioğlu AS, Hatemi G, Yücel A, De Hoog GS, Mandel NM (2003). "Paecilomyces variotii central nervous system infection in a patient with cancer". Mycoses. 46 (1–2): 45–50. PMID 12588483.
  20. ↑ 20.0 20.1 20.2 Fagerburg R, Suh B, Buckley HR, Lorber B, Karian J (1981). "Cerebrospinal fluid shunt colonization and obstruction by Paecilomyces variotii. Case report". J Neurosurg. 54 (2): 257–60. doi:10.3171/jns.1981.54.2.0257. PMID 7192726.
  21. ↑ 21.0 21.1 21.2 Kutleša M, Mlinarić-Missoni E, Hatvani L, Voncina D, Simon S, Lepur D; et al. (2012). "Chronic fungal meningitis caused by Aureobasidium proteae". Diagn Microbiol Infect Dis. 73 (3): 271–2. doi:10.1016/j.diagmicrobio.2012.03.007. PMID 22504065.
  22. ↑ 22.0 22.1 22.2 Krcmery V, Mateicka F, Grausova S, Kunova A, Hanzen J (1999). "Invasive infections due to Clavispora lusitaniae". FEMS Immunol Med Microbiol. 23 (1): 75–8. PMID 10030550.
  23. ↑ 23.0 23.1 23.2 MOORE M, RUSSELL WO, SACHS E (1946). "Chronic leptomeningitis and ependymitis caused by Ustilago, probably U. zeae (corn smut)". Am J Pathol. 22: 761–77. PMID 20991975.
  24. ↑ 24.0 24.1 24.2 Centers for Disease Control and Prevention (CDC) (2002). "Exophiala infection from contaminated injectable steroids prepared by a compounding pharmacy--United States, July-November 2002". MMWR Morb Mortal Wkly Rep. 51 (49): 1109–12. PMID 12530707.
  25. ↑ 25.0 25.1 25.2 25.3 Pettit AC, Pugh ME (2013). "Index case for the fungal meningitis outbreak, United States". N Engl J Med. 368 (10): 970. doi:10.1056/NEJMc1300630. PMID 23465119.
  26. ↑ 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.
  27. ↑ Williamson PR, Jarvis JN, Panackal AA, Fisher MC, Molloy SF, Loyse A; et al. (2017). "Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy". Nat Rev Neurol. 13 (1): 13–24. doi:10.1038/nrneurol.2016.167. PMID 27886201.
  28. ↑ Mitchell TG, Perfect JR (1995). "Cryptococcosis in the era of AIDS--100 years after the discovery of Cryptococcus neoformans". Clin Microbiol Rev. 8 (4): 515–48. PMC 172874. PMID 8665468.
  29. ↑ Perfect JR, Casadevall A (2002). "Cryptococcosis". Infect Dis Clin North Am. 16 (4): 837–74, v–vi. PMID 12512184.
  30. ↑ Bouza E, Dreyer JS, Hewitt WL, Meyer RD (1981). "Coccidioidal meningitis. An analysis of thirty-one cases and review of the literature". Medicine (Baltimore). 60 (3): 139–72. PMID 7231152.
  31. ↑ Johnson RH, Einstein HE (2006). "Coccidioidal meningitis". Clin Infect Dis. 42 (1): 103–7. doi:10.1086/497596. PMID 16323099.
  32. ↑ Bariola JR, Perry P, Pappas PG, Proia L, Shealey W, Wright PW; et al. (2010). "Blastomycosis of the central nervous system: a multicenter review of diagnosis and treatment in the modern era". Clin Infect Dis. 50 (6): 797–804. doi:10.1086/650579. PMID 20166817.
  33. ↑ Pappas PG, Pottage JC, Powderly WG, Fraser VJ, Stratton CW, McKenzie S; et al. (1992). "Blastomycosis in patients with the acquired immunodeficiency syndrome". Ann Intern Med. 116 (10): 847–53. PMID 1567099.
  34. ↑ de Almeida SM (2005). "Central nervous system paracoccidioidomycosis: an overview". Braz J Infect Dis. 9 (2): 126–33. doi:/S1413-86702005000200002 Check |doi= value (help). PMID 16127588.
  35. ↑ de Almeida SM, Queiroz-Telles F, Teive HA, Ribeiro CE, Werneck LC (2004). "Central nervous system paracoccidioidomycosis: clinical features and laboratorial findings". J Infect. 48 (2): 193–8. PMID 14720496.
  36. ↑ Freitas DF, de Siqueira Hoagland B, do Valle AC, Fraga BB, de Barros MB, de Oliveira Schubach A; et al. (2012). "Sporotrichosis in HIV-infected patients: report of 21 cases of endemic sporotrichosis in Rio de Janeiro, Brazil". Med Mycol. 50 (2): 170–8. doi:10.3109/13693786.2011.596288. PMID 21859385.
  37. ↑ Silva-Vergara ML, Maneira FR, De Oliveira RM, Santos CT, Etchebehere RM, Adad SJ (2005). "Multifocal sporotrichosis with meningeal involvement in a patient with AIDS". Med Mycol. 43 (2): 187–90. PMID 15832562.
  38. ↑ Assi MA, Sandid MS, Baddour LM, Roberts GD, Walker RC (2007). "Systemic histoplasmosis: a 15-year retrospective institutional review of 111 patients". Medicine (Baltimore). 86 (3): 162–9. doi:10.1097/md.0b013e3180679130. PMID 17505255.
  39. ↑ Wheat LJ, Musial CE, Jenny-Avital E (2005). "Diagnosis and management of central nervous system histoplasmosis". Clin Infect Dis. 40 (6): 844–52. doi:10.1086/427880. PMID 15736018.
  40. ↑ Kantarcioglu AS, Guarro J, de Hoog GS (2008). "Central nervous system infections by members of the Pseudallescheria boydii species complex in healthy and immunocompromised hosts: epidemiology, clinical characteristics and outcome". Mycoses. 51 (4): 275–90. doi:10.1111/j.1439-0507.2008.01489.x. PMID 18331448.
  41. ↑ Panichpisal K, Nugent K, Sarria JC (2006). "Central nervous system pseudallescheriasis after near-drowning". Clin Neurol Neurosurg. 108 (4): 348–52. doi:10.1016/j.clineuro.2005.10.013. PMID 16325994.
  42. ↑ Al-Tawfiq JA, Boukhamseen A (2011). "Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei (formerly Ramichloridium mackenziei): case presentation and literature review". J Infect Public Health. 4 (2): 96–102. doi:10.1016/j.jiph.2011.01.001. PMID 21663879.
  43. ↑ 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.
  44. ↑ 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.
  45. ↑ 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.
  46. ↑ Jantunen E, Volin L, Salonen O, Piilonen A, Parkkali T, Anttila VJ; et al. (2003). "Central nervous system aspergillosis in allogeneic stem cell transplant recipients". Bone Marrow Transplant. 31 (3): 191–6. doi:10.1038/sj.bmt.1703812. PMID 12621480.
  47. ↑ 47.0 47.1 Mylonakis E, Paliou M, Sax PE, Skolnik PR, Baron MJ, Rich JD (2000). "Central nervous system aspergillosis in patients with human immunodeficiency virus infection. Report of 6 cases and review". Medicine (Baltimore). 79 (4): 269–80. PMID 10941356.
  48. ↑ Antinori S, Corbellino M, Meroni L, Resta F, Sollima S, Tonolini M; et al. (2013). "Aspergillus meningitis: a rare clinical manifestation of central nervous system aspergillosis. Case report and review of 92 cases". J Infect. 66 (3): 218–38. doi:10.1016/j.jinf.2012.11.003. PMID 23178421.
  49. ↑ Jones PG, Gilman RM, Medeiros AA, Dyckman J (1981). "Focal intracranial mucormycosis presenting as chronic meningitis". JAMA. 246 (18): 2063–4. PMID 7288994.
  50. ↑ Surmont I, Vergauwen B, Marcelis L, Verbist L, Verhoef G, Boogaerts M (1990). "First report of chronic meningitis caused by Trichosporon beigelii". Eur J Clin Microbiol Infect Dis. 9 (3): 226–9. PMID 2338090.
  51. ↑ Heslop OD, Nyi Nyi MP, Abbott SP, Rainford LE, Castle DM, Coard KC (2011). "Disseminated trichosporonosis in a burn patient: meningitis and cerebral abscess due to Trichosporon asahii". J Clin Microbiol. 49 (12): 4405–8. doi:10.1128/JCM.05028-11. PMC 3232981. PMID 22012010.
  52. ↑ "From the Centers for Disease Control and Prevention. Exophiala infection from contaminated injectable steroids prepared by a compounding pharmacy--United States, July-November 2002". JAMA. 289 (3): 291–3. 2003. PMID 12532960.
  53. ↑ Smith RM, Schaefer MK, Kainer MA, Wise M, Finks J, Duwve J; et al. (2013). "Fungal infections associated with contaminated methylprednisolone injections". N Engl J Med. 369 (17): 1598–609. doi:10.1056/NEJMoa1213978. PMID 23252499.
  54. ↑ 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.

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