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Fungal meningitis

  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 2 Jun 2025
最后更新： 13 Jun 2023

小结

定义

病史和体格检查

关键诊断因素

  • 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
完整详情

其他诊断因素

  • 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
完整详情

危险因素

  • 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
完整详情

诊断性检查

首要检查

  • 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
完整详情

需考虑的检查

  • histopathology and culture of biopsies: meningeal, brain, extraneural sites of involvement
  • polymerase chain reaction (PCR)
完整详情

新兴检查

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

治疗流程

急症处理

cryptococcal meningitis

histoplasmal meningitis

coccidioidal meningitis

candidal meningitis

Exserohilum rostratum meningitis

Aspergillus meningitis

mucormycosal meningitis

撰稿人

作者

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

Consultant Neurologist

Clinical Lead of Neuroinflammation

Department of Neurology

Queen's Hospital

Romford

UK

利益声明

AC declares that he has no competing interests.

鸣谢

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

利益声明

TSH and AL declare that they have no competing interests.

同行评议者

Robert A. Larsen, MD

Associate Professor of Medicine

University of Southern California

Keck School of Medicine

Los Angeles

CA

利益声明

RAL declares that he has no competing interests.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

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

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

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].全文

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.全文  摘要

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.全文  摘要

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

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.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Fungal meningitis images

  • 鉴别诊断

    • Tuberculous meningitis
    • Bacterial meningitis
    • Viral meningitis
    更多 鉴别诊断

  • 指南

    • Guidelines for diagnosing, preventing, and managing cryptococcal disease among adults, adolescents and children living with HIV
    • Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
    更多 指南

  • 患者教育信息

    Lumbar puncture

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