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Fungal meningitis

  • Обзор
  • Теория
  • Диагноз
  • Лечение
  • Последующее наблюдение
  • Источники
Последний просмотренный: 16 Aug 2025
Last updated: 13 Jun 2023

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • progressive headache
  • severe headache
  • meningismus
  • symptoms of hydrocephalus (impaired cognitive function, confusion, coordination and gait disturbances, and urinary incontinence)
  • behavioral or personality change
  • reduced visual acuity and papilledema
Полная информация

Другие диагностические факторы

  • nausea or vomiting
  • fever
  • reduced conscious level
  • cranial nerve palsies
  • seizures
  • weight loss
  • mouth ulcers
  • focal neurologic signs
  • lymphadenopathy, hepatosplenomegaly
  • dyspnea
  • papular umbilicated skin lesions
  • retinal defects
  • nasal or palatal eschar
Полная информация

Факторы риска

  • HIV infection
  • corticosteroid use
  • underlying chronic disease (e.g., malignancy, organ failure, autoimmune disease, organ transplant)
  • residing in or visiting northern Australia, Papua New Guinea, or Vancouver Island, Canada
  • exposure to disturbed soil, chicken guano, or bat caves
  • impaired cell-mediated immunity
  • Filipinos and African Americans
  • neutropenia or impaired phagocytic function
  • neurosurgery
  • infants and neonates
  • central vascular catheters
  • sinonasal disease
  • antibacterial usage
  • prior surgery
  • hyperalimentation
  • intravenous drug use
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • CT and/or MRI head scan
  • fungal blood cultures (3 sets)
  • serum cryptococcal antigen test
  • serum + urine Histoplasma antigen
  • immunodiffusion tests (IgM and IgG) and complement fixation test (IgG) for coccidioidomycosis
  • cerebrospinal fluid opening pressure
  • cerebrospinal fluid (CSF) WBC and differential
  • cerebrospinal fluid (CSF) protein
  • cerebrospinal fluid (CSF) glucose
  • cerebrospinal fluid India ink stain
  • cerebrospinal fluid (CSF) culture
  • cerebrospinal fluid cryptococcal polysaccharide antigen test
  • cerebrospinal fluid Histoplasma antigen
  • cerebrospinal fluid Histoplasma antibodies
  • cerebrospinal fluid coccidioidal IgG antibodies
  • cerebrospinal fluid (CSF) galactomannan antigen test
Полная информация

Исследования, проведение которых нужно рассмотреть

  • histopathology and culture of biopsies: meningeal, brain, extraneural sites of involvement
  • polymerase chain reaction (PCR)
Полная информация

Неотложные исследования

  • 18F-fluorodeoxyglucose (FDG) PET/CT
  • cerebrospinal fluid (CSF) (1-3)-beta-D-glucan

Алгоритм лечения

Острый

cryptococcal meningitis

histoplasmal meningitis

coccidioidal meningitis

candidal meningitis

Exserohilum rostratum meningitis

Aspergillus meningitis

mucormycosal meningitis

Составители

Авторы

Abhijit Chaudhuri, DM, MD, PhD, FACP, FRCP (Glasg), FRCP (Lond)

Consultant Neurologist

Clinical Lead of Neuroinflammation

Department of Neurology

Queen's Hospital

Romford

UK

Раскрытие информации

AC declares that he has no competing interests.

Выражение благодарностей

Dr Abhijit Chaudhuri would like to gratefully acknowledge Dr Thomas S. Harrison and Dr Angela Loyse, previous contributors to this topic.

Раскрытие информации

TSH and AL declare that they have no competing interests.

Рецензенты

Robert A. Larsen, MD

Associate Professor of Medicine

University of Southern California

Keck School of Medicine

Los Angeles

CA

Раскрытие информации

RAL declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

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Основные статьи

Johnson RH, Einstein HE. Coccidioidal meningitis. Clin Infect Dis. 2006 Jan 1;42(1):103-7.Полный текст  Аннотация

World Health Organization. Guidelines for diagnosing, preventing and managing cryptococcal disease among adults, adolescents and children living with HIV. June 2022 [internet publication].Полный текст  Аннотация

National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association of the Infectious Disease Society of America. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. September 2022 [internet publication].Полный текст

Galgiani JN, Ampel NM, Blair JE, et al. 2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis. Clin Infect Dis. 2016 Sep 15;63(6):e112-46.Полный текст  Аннотация

Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4):e1-50.Полный текст  Аннотация

Johnson RH, Einstein HE. Coccidioidal meningitis. Clin Infect Dis. 2006 Jan 1;42(1):103-7.Полный текст  Аннотация

Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Aug 15;63(4):e1-60.Полный текст  Аннотация

Статьи, указанные как источники

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