June 19, 2009
Meningitis is the most common illness caused by cryptococcus. Meningitis is an infection of the lining of the spinal cord and brain. It can cause coma and death. Cryptococcus can also infect the skin, lungs, or other parts of the body. The risk of cryptococcal infection is highest when your CD4 counts are below 50.
The first signs of meningitis include fever, fatigue, a stiff neck, headache, nausea and vomiting, confusion, blurred vision or sensitivity to bright lights. The symptoms may come on slowly.
HIV disease or medications can also cause these symptoms. Therefore, laboratory tests are used to confirm that you have meningitis.
The tests use blood or spinal fluid. Health care providers get spinal fluid by doing a spinal tap. A needle is inserted into the middle of your back just above your hips. The needle removes a sample of spinal fluid. The pressure of the spinal fluid can also be measured. If the pressure is too high, the health care provider may drain some of the fluid. The test is safe and usually not too painful. However, after a spinal tap, some people get headaches that can last a few days.
The blood or spinal fluid can be tested for cryptococcus in two ways. A "CRAG" test looks for an antigen (a protein) produced by cryptococcus. A "culture" is a way to see if the cryptococcus fungus can be grown from the sample of spinal fluid. CRAG tests are quick and can produce same-day results. A culture can take a week or more to show a positive result. Spinal fluid can also be tested quickly using a stain.
Amphotericin B is a very strong drug. It is given as an injection or a slow intravenous (IV) infusion. Both of these drugs can have serious side effects. Side effects can be reduced by taking Advil or Tylenol a half hour before taking the drug. In a newer form of amphotericin, the medication is encased in fat bubbles (liposomes). This form may have fewer side effects. Cryptococcal meningitis comes back after the first time in about half of the people who get it. Repeat cases are reduced if people keep taking antifungal drugs.
For some people, draining spinal fluid daily to reduce pressure on the brain is also part of treatment.
Starting antiretroviral therapy (ART) can cause problems if you have had cryptococcal infection for a short time. These cases are believed to be a sign of immune restoration syndrome (see Fact Sheet 483). Talk to your health care provider.
If meningitis is diagnosed early enough, it can be treated without using amphotericin B. The usual treatment, however, is two weeks of amphotericin B followed by oral fluconazole. Without ART, fluconazole is continued for life. Without it, the meningitis is likely to come back. Patients on ART can stop taking fluconazole if their CD4 cell count goes over 200 and stays there for at least six months.
If you get cryptococcal meningitis, early diagnosis might allow treatment with less toxic drugs. Contact your health care provider if you have headaches, a stiff neck, vision problems, confusion, nausea, or vomiting.
If you develop cryptococcal meningitis, you may have to continue taking antifungal drugs to prevent the disease from coming back.