Fungal meningitis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]


Fungal meningitis is usually classified according to the causative organism if identified. It may also be additionally classified according to the severity and duration of the disease as: mild, moderate, severe, acute, subacute, chronic and recurrent fungal meningitis.[1][2][3][4][5][6][7][8][9]


Although fungal meningitis has no formal classification system, it is usually classified according to the causative organism if identified. It may however be additionally classified according to the severity and duration of the disease as shown below:[1][2][3][4][5][6][7][8][9]

According to severity of the disease
  • May present late with typical or atypical symptoms
  • May present with complications
  • Variable response to treatment
  • Presents with complications or prolonged illness
  • Immunocompromised
  • Common in extremes of age
  • Delayed diagnosis and treatment
  • Surgical treatment may be required in addition to medical treatment
  • Increased morbidity and mortality
According to the duration of disease[1]
  • Lasts more than 4 weeks[9]
  • Gradual deterioration of patient
  • Prolonged history of atypical symptoms
  • Common in older patients
  • Multiple episodes which lasts less than 4 weeks
  • History of incompliance to medication
  • immunosuppression may be the underlying cause

Subclassification according to fungal pathogen

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

1. Primary fungal pathogens of humans

All of these may cause CNS infections. These include; Cryptococcus neoformans,[10][11] Coccidioides immitis,[12][13] Blastomyces dermatitidis,[14][15] Paracoccidioides brasiliensis,[16][17] Sporothrix schenckii,[18][19] Histoplasma capsulatum,[20][21] Pseudallescheria boydii (scedosporium apiospermum),[22][23] dematiaceous fungi,[24]

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: Candida species,[25][26][27] Aspergillus species,[28][29][29][30] mucormycosis,[31] and Trichosporon species.[32][33]


  1. 1.0 1.1 1.2 Zheng H, Chen Q, Xie Z, Wang D, Li M, Zhang X; et al. (2016). "A retrospective research of HIV-negative cryptococcal meningoencephalitis patients with acute/subacute onset". Eur J Clin Microbiol Infect Dis. 35 (2): 299–303. doi:10.1007/s10096-015-2545-0. PMID 26792138.
  2. 2.0 2.1 Zunt JR, Baldwin KJ (2012). "Chronic and subacute meningitis". Continuum (Minneap Minn). 18 (6 Infectious Disease): 1290–318. doi:10.1212/01.CON.0000423848.17276.21. PMID 23221842.
  3. 3.0 3.1 Chimalizeni Y, Tickell D, Connell T (2010). "Evidence behind the WHO guidelines: hospital care for children: what is the most appropriate anti-fungal treatment for acute cryptococcal meningitis in children with HIV?". J Trop Pediatr. 56 (1): 4–12. doi:10.1093/tropej/fmp123. PMID 20097705.
  4. 4.0 4.1 Malessa R, Krams M, Hengge U, Weiller C, Reinhardt V, Volbracht L; et al. (1994). "Elevation of intracranial pressure in acute AIDS-related cryptococcal meningitis". Clin Investig. 72 (12): 1020–6. PMID 7711408.
  5. 5.0 5.1 Saag MS, Powderly WG, Cloud GA, Robinson P, Grieco MH, Sharkey PK; et al. (1992). "Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. The NIAID Mycoses Study Group and the AIDS Clinical Trials Group". N Engl J Med. 326 (2): 83–9. doi:10.1056/NEJM199201093260202. PMID 1727236.
  6. 6.0 6.1 Sloan D, Dlamini S, Paul N, Dedicoat M (2008). "Treatment of acute cryptococcal meningitis in HIV infected adults, with an emphasis on resource-limited settings". Cochrane Database Syst Rev (4): CD005647. doi:10.1002/14651858.CD005647.pub2. PMID 18843697.
  7. 7.0 7.1 Witt MD, Lewis RJ, Larsen RA, Milefchik EN, Leal MA, Haubrich RH; et al. (1996). "Identification of patients with acute AIDS-associated cryptococcal meningitis who can be effectively treated with fluconazole: the role of antifungal susceptibility testing". Clin Infect Dis. 22 (2): 322–8. PMID 8838190.
  8. 8.0 8.1 Morgand M, Rammaert B, Poirée S, Bougnoux ME, Tran H, Kania R; et al. (2015). "Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole". Antimicrob Agents Chemother. 59 (12): 7857–61. doi:10.1128/AAC.01506-15. PMC 4649149. PMID 26392507.
  9. 9.0 9.1 9.2 Banarer M, Cost K, Rychwalski P, Bryant KA (2005). "Chronic lymphocytic meningitis in an adolescent". J Pediatr. 147 (5): 686–90. doi:10.1016/j.jpeds.2005.07.010. PMID 16291364.
  10. 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.
  11. Perfect JR, Casadevall A (2002). "Cryptococcosis". Infect Dis Clin North Am. 16 (4): 837–74, v–vi. PMID 12512184.
  12. 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.
  13. Johnson RH, Einstein HE (2006). "Coccidioidal meningitis". Clin Infect Dis. 42 (1): 103–7. doi:10.1086/497596. PMID 16323099.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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.
  26. 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.
  27. 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.
  28. 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.
  29. 29.0 29.1 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.
  30. 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.
  31. Jones PG, Gilman RM, Medeiros AA, Dyckman J (1981). "Focal intracranial mucormycosis presenting as chronic meningitis". JAMA. 246 (18): 2063–4. PMID 7288994.
  32. 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.
  33. 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.

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