What is Fungal Meningitis?

Meningitis is an infection that causes swelling in the protective membranes that surround the brain and spinal cord. It can be very serious and will sometimes cause complications, including sepsis.

There are different types of meningitis, including bacterial, viral, chemical, amoebic/ parasitic and fungal. Meningitis can affect anyone but is most common in babies, young children, adolescents and people with a weakened immune system.

Meningitis is estimated to affect over 2 million people each year, with around 1 in 10 cases of bacterial meningitis resulting in death.

The majority of instances of meningitis are caused by viruses or bacteria. Viral meningitis is the most common form of the condition. Fungal meningitis is one of the rarer forms of meningitis, usually only causing adverse effects in immunocompromised people such as those living with HIV or AIDS.

Fungal meningitis can sometimes occur if a fungal infection is able to spread to the brain or spinal cord from elsewhere in the body.

The fungi responsible for causing fungal meningitis can be found in the environment in some parts of the world. For many people, if they are exposed to these fungi, they will experience mild effects or no effects at all. However, the prognosis is different for people with a weakened immune system.

The pathogen responsible for causing a fungal infection that can lead to meningitis can be found in various places within the environment.

Such as:

Soil.
Water.
Air.
Vegetation.
Food.
Decomposing matter (leaves, wood etc).

You need to be especially careful if you live in an area of the world where certain fungi exist.

These fungi include:

Blastomyces – Breathing in the spores of this fungus can cause an infection called Blastomycosis. Fungal meningitis can occur as a complication of getting this infection. This fungus lives in moist soil, especially in decomposing wood, leaves and other natural materials. In the US this fungus lives in the mid-west, south-central and south-eastern states.
Coccidioides – A soil-dweller, found in Mexico and other parts of Central and South America, as well as parts of southwestern US and south-central Washington State.
Histoplasma – This fungus is often concentrated in areas that contain high levels of bird or bat droppings. People often encounter this fungus when these droppings are disturbed, such as during a large-scale clean-up operation or as an old building is torn down.
Cryptococcus – This fungus can be found in soil and in the environment around the world. Inhaling the spores of this fungus can lead to a potentially life-threatening condition called Cryptococcosis.
Candida is a yeast that usually lives in the body or on the skin without causing any issues; however, overgrowth of candida is responsible for causing yeast infections such as thrush. Occasionally, it can cause fungal meningitis in people with a weak immune response, by getting into the bloodstream or internal organs.

Living in a higher-risk area might mean that you have a higher chance of encountering fungal spores and getting a fungal lung infection. If these infections are able to spread to the brain or spinal cord they will cause complications, including fungal meningitis.

What causes fungal meningitis?

Fungal meningitis is caused by microscopic pathogens that can be breathed in. These tiny fungi particles can cause an infection in the lungs. If this infection spreads to the brain and spinal cord some people may develop fungal meningitis.

It is difficult to actively prevent fungal meningitis. If you have a weakened immune system for some reason, you will need to take extra precautions when doing certain activities that could put you at a higher risk of encountering fungi that can lead to meningitis developing.

People may have a weakened immune system due to a long-term health issue such as cancer or HIV or a short-term infection such as influenza (flu). The immune system can also be weaker whilst recovering from surgery and from certain medicines.

Such as:

Medications that are given post-organ transplant.
Anti-TNF medications that treat rheumatoid arthritis and some autoimmune conditions.
Steroids such as those used to treat lupus, asthma or IBD.

When fungal spores are breathed in, they can become lodged inside blood vessels in the body. This causes the restriction of blood flow and increases blood pressure. These tiny fungal spores can grow inside blood vessels, making them stretch and eventually burst. This is when infectious microbes can make their way into the brain and cause meningitis.

Signs and symptoms of fungal meningitis

Many of the indicators of fungal meningitis are similar to the symptoms of other forms of meningitis, although this form is considered rare.

The following signs and symptoms may indicate fungal meningitis:

A stiff neck.
Fever/high temperature.
Headache.
Nausea and sickness.
Your eyes being extra sensitive to light (photophobia).
Feelings of confusion or disordered thinking.

Fungal meningitis cannot spread from person to person, but it can make you very ill if you are infected with it. This is why it is important to get a diagnosis as soon as you can.

Suffering headaches from fungal meningitis

How is fungal meningitis diagnosed?

If you are experiencing symptoms of meningitis or have concerns about your health you will need to see a doctor as soon as possible.

You may need to answer some questions about your general health and medical history.

This may include collecting information relating to:

The symptoms you are experiencing, how severe they are and how long you have had them.
Any relevant medical history.
Any medications you are currently taking.
Your general health and lifestyle.
Any autoimmune problems that you have.

Meningitis symptoms can get worse rapidly and it is important that you receive medical attention quickly. This might mean getting to the emergency department or dialling 999 for an ambulance.

If a doctor thinks that you have fungal meningitis, they will want to collect samples from you to send off to a lab for testing.

This may include taking samples of:

Blood.
Fluid from around the spinal cord (cerebrospinal fluid).

The sample of spinal fluid will be taken using a procedure called a lumbar puncture or spinal tap. This is a diagnostic test used to check for a number of health conditions and infections relating to the central nervous system.

The samples will be checked and the specific type of fungus that is causing meningitis will need to be isolated. This is because, in order for treatment to be successful, the correct treatment needs to be used in order to target the correct fungus; different fungal infections are treated in different ways.

In an emergency, the results will be expedited and should be available in just a few hours so that the correct treatment can begin.

How is fungal meningitis treated?

If you have fungal meningitis, you will normally have to take a long-term course of anti-fungal medication. Initially, this medication may be administered directly into the bloodstream through an IV drip. You will likely need to follow up the IV treatment by taking oral anti-fungal medication.

The length of treatment will vary depending on the type of fungus that has caused the infection, how soon treatment began and the general health of the patient. People with a severe autoimmune condition (such as AIDS) will usually receive treatment for extended periods of time.

Patients will need to be treated with the best medication to combat the specific type of fungus they have been infected by.

Medications routinely used to treat fungal meningitis include:

Amphotericin B (Fungizone).
Flucytosine (Ancobon).
Fluconazole (Diflucan).
Itraconazole (Sporanox).

Most patients who seek prompt treatment for fungal meningitis will eventually make a full recovery and suffer no long-term effects. It is normal for patients to feel generally unwell, tired and lacking in energy whilst they receive their anti-fungal treatment for meningitis.

If you have had your life affected by meningitis you can contact the national support helpline for help and advice from trained experts (the helpline cannot offer clinical diagnoses or medical advice).

Risk factors for fungal meningitis and prevention

If you know that you have a weakened immune system, you may want to check whether you are in a geographic area that contains any of the fungi known to cause fungal meningitis.

This is especially true if you live in an exceptionally dusty area, one that is prone to sandstorms or if you work in an industry that puts you at a higher risk of encountering these pathogens (such as farming or demolition).

As these fungal spores are so tiny, they are invisible to the naked eye and it is impossible to completely prevent breathing them in. However, you may want to take some steps to minimise the chances of developing fungal meningitis, especially if you are identified as belonging to a high-risk group.

Such as:

Using indoor air filtration systems.
Consider using an N95 respirator mask if you have to go into any dusty areas.
Avoid high-risk areas where the earth or environment has been disturbed, causing dust clouds, such as excavation sites or building sites.
Remain indoors during dust storms or sandstorms and keep windows and doors closed.
Try to avoid activities that mean you may come into contact with pathogens such as gardening or digging.
Practise good hygiene and always wash any cuts or wounds with soap and water to prevent an infection.
Speak to your doctor regarding preventative measures or preventative medication that may help reduce the risk of developing fungal meningitis.

The Meningitis Research Foundation identifies some of the long-term effects of suffering from meningitis which include headaches, memory loss, problems with balance, vision or speech and weakness.

As fungal meningitis is a particular threat to those with an already weakened immune system, it is vital that anyone in this category takes extra precautions around their health on a daily basis. This includes avoiding exposure to pathogens as far as possible, so as not to incur any additional health issues or illnesses.

Fungal meningitis remains rare and is not considered a threat to the general population. People with a weak immune system, however, should take steps to protect themselves from exposure to potentially dangerous fungal spores and must seek medical treatment for any symptoms of fungal meningitis immediately.