Term
| Most fungal meningitis cases are chronic/subacute and have a lymphocyte predominance. However, name 4 fungal species that cause neutrophilic meningitis. |
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Definition
Aspergillus
Scedosporium
Blastomyces
Zygomycetes |
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Term
Which produces more CNS torulomas?
Cryptococcus neoformans (serotypes A,D)
Cryptococcus gattii (serotypes B,C) |
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Definition
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Term
| Treatment of Cryptococcal Meningitis is done in 3 phases. Name them. |
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Definition
Induction: Amphotericin B + Flucytosine (2 wks)
Clearance/Consolidation: Fluconazole (8wks)
Suppressive: Fluconazole (1-2 years) |
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Term
| CSF eosinophilia is common in this fungal meningitis |
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Definition
coccidioidal meningitis; because of TH2 response
Also blastomyces meningitis |
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Term
| which fungal meningitis requires large volume CSF taps for culture due to low burden? |
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Definition
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Term
| fungal meningitis tt presents in normal host to immunosuppressed host |
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Definition
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Term
which species of mould causes meningitis and has the following risk factors:
near freshwater drownings
corticosteroids
diabetes |
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Definition
scedosporium apiospermum (P. boydii)
(a hyalohyphomycosis) |
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Term
what mould species has the following characteristics:
causes brain abscesses
travels from sinus disease/ direct trauma in brain
causes Wangiella meningitis
Surgery management is appropriate |
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Definition
Phaeohyphomycosis (black mould)
-cladophialophora bantianum |
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Term
Risk group for this fungal infection:
Neutropenia, GVD, AIDS
-rarely causes meningitis |
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Definition
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Term
Risk group for this fungal meningitis:
Antibiotics, Trauma, neonates, IVDA, neutropenia, neurosurgery, WBC defects eg myeloperoxidase deficiency
-may causes meningitis or brain abscess
-positive cultures from VA/VP shunts |
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Definition
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Term
-direct extension from sinuses/infarctions
-causes meningitis, abscess, rhinocerebral disease
-risk factors; diabetes, chelation therapy, IVDA, cancer, voriconazole therapy
-Treat w lipid products of Amphotericin B |
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Definition
| Zygomycosis (Rhizopus is most common) |
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Term
| antifungal drugs for CNS infection |
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Definition
Ambisome>ABCD>ABLC (CNS penetration)
Fluconazole=Flucytosine>Voriconazole>Itraconazole = Caspofungin (CNS penetration)
Combinations:
AMB + 5FC
FLU + 5FC
AMB + FLU |
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Term
| Treatment of Coccidoidal meningitis |
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Definition
Induction: Amphotericin B (0.5-1gm total)
Clearance: fluconazole (800mg/day)
Suppression: fluconazole (200-400mg/day) for a LIFETIME
**incurable! |
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Term
| Treatment of candida meningitis |
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Definition
Amphotericin B + Flucytosine
or
Fluconazole
or AmB + fluconazole |
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Term
| Treatment of Histoplasma, Sporothrix, and blastomyces meningitis |
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Definition
Success in ~50% cases
Induction: Ambisome
Clearance: Itraconazole |
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Term
| Treatment of CNS mould infections: Aspergillus, Scedosporium, Coccidioides, Histoplasma, Black moulds, zygomycetes |
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Definition
Voriconazole (CNS Aspergillosis)
or
Posaconazole (CNS Scedosporiosis) |
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Term
| When to use surgical measures in fungal CNS infections? |
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Definition
Meningeal or brain biopsy for diagnosis
Torulomas > 3cm
Infarcted tissue (Zygomycetes/Aspergillus)
Mycotic Aneurysms
Phaeohyphomycosis (Cladophialophora bantiana)
Shunt placement for increased ICP |
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