Fungal meningitis

Introduction to fungal meningitis Fungal meningitis is inflammation caused by fungal invasion of the meninges, often accompanied by brain parenchymal infections, and belongs to deep mycosis. With the high dose and long-term application of antibiotics, hormones, immunosuppressive drugs, especially after organ transplantation, the increase of AIDS and the increase of family animals, the incidence of central nervous system fungal infections has an increasing trend. Pathogenic fungi and conditional pathogens that cause central nervous system fungal infections. The former has Cryptococcus neoformans, Aspergillus sp., dermatitis buds, Paraspora, S. sphaericus, capsular histoplasma, etc.; the latter has Candida, Aspergillus, zygomycetes, Trichosporium, etc. . basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: disturbance of consciousness, hemiplegia, convulsions and convulsions

Cause of fungal meningitis

Fungal diseases have gradually increased in recent years and may be related to the following reasons.

:1 For a variety of reasons, the number of patients who have used broad-spectrum antibiotics, immunosuppressive agents, corticosteroids, and anticancer drugs for a long time has increased. These iatrogenic factors are easy to induce systemic fungal infections;

2 Due to advances in medical technology, the lifespan of patients with diseases such as leukemia, malignant tumors, diabetes, uremia, immune dysfunction and autoimmune diseases has prolonged. The existence of these basic diseases provides disease for fungal diseases. conditions of;

3 clinicians have increased vigilance against fungal diseases;

4 The laboratory diagnostic techniques for fungal culture have been greatly improved.

Fungal meningitis prevention

1. Pigeons may be the main source of infection, pay attention to prevent infection through this route.

2. The new type of cryptococcus is inhaled by the respiratory tract; pay attention to enhance physical fitness and prevent upper respiratory tract infection.

3. Avoid long-term application of broad-spectrum antibiotics and immunosuppressive drugs.

4. Prevention of tuberculosis, diabetes, etc. may cause cryptococcal meningitis or meningoencephalitis.

5. Early comprehensive treatment to reduce complications and reduce mortality.

Fungal meningitis complications Complications, dysfunction, convulsions, convulsions

1. There may be varying degrees of disturbance of consciousness, mental disorders, and restlessness.

2. Skull base arachnoiditis, optic nerve damage is the most common, followed by VIII, III, VII, VI cranial nerve damage.

3. Some patients may have symptoms of focal brain tissue damage such as hemiplegia, convulsions and aphasia.

Fungal meningitis symptoms common symptoms convulsions high fever nausea neck tough vomiting severe headache

Mostly subacute disease, a small number of chronic onset.

First, general systemic symptoms

1. Early infections such as mild to moderate fever, and high fever in the late stage.

2, neck stiffness, Klinefelter positive and other meningeal irritation.

3, headache, nausea, vomiting, optic nerve head edema and other intracranial pressure increased. Late headaches are severe, and even convulsions, cerebral insufficiency and cerebral palsy.

Second, the nervous system symptoms

1, multiple cranial nerve damage symptoms: visual acuity impaired when vision is low or even blind, other eye movements, abduction, face and auditory nerves are often susceptible to the emergence of corresponding neurological symptoms and signs.

2, brain damage symptoms: when the lesion affects the brain parenchyma and / and the formation of intracerebral granuloma, clinical symptoms such as drowsiness, irritability, paralysis and other focal symptoms and sputum may be associated with mental disorders And the disturbance of consciousness, in severe cases, into a coma.

Third, multiple or multiple infection symptoms These patients are often due to weak constitution, poor nutrition and decreased immune function, often accompanied by new infections of other strains or potential recurrence of infections in the body, common with tuberculosis and / or the presence of toxoplasmosis, etc., to make the disease more serious and complex and clinical manifestations of diversification, and even become an important cause of death of patients, worthy of attention and timely determination.

Examination of fungal meningitis

First, cerebrospinal fluid

The pressure is increased and the appearance is transparent or slightly turbid. The white blood cell count was mild to moderate (20-700)×10/L), and even reached 5000×10/L, and lymphocyte increase was the main factor. The protein content is increased (0.4g ~ 1g / L), even high. Sugar and chloride levels are reduced.

Cerebrospinal fluid smear ink staining / / and cerebrospinal fluid cell slide centrifugation sedimentation method of Giemsa, Wright's composite staining tablets, can be found in a pile of cryptococcus globosa, part of cryptococcus can also see spore growth. The capsular capsule (not stained) of the former method is bright, and the dark blue and the capsule of the latter are burr-like (see the following figure); the cerebrospinal fluid cryptococcal culture is mostly positive, which can provide a basis for the diagnosis of clinical etiology.

Second, immunological examination

The positive rate of cryptococcal antigen in blood and cerebrospinal fluid lactic acid agglutination test and enzyme-linked immunosorbent test is higher, which can help the cause of the disease.

Third, image examination

Imaging studies such as CT or MRI of the brain suggest brain edema, hydrocephalus and focal abnormalities of the brain. Granuloma in the brain parenchyma can be expressed as a T1 or the like with a slightly lower signal and a significantly higher signal change in T2 on MRI.

Diagnosis and identification of fungal meningitis

Need to be diagnosed with purulent meningitis, viral meningitis, tuberculous meningitis.

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