Cryptococcal Meningitis
Cryptococcal meningitis is a potentially life-threatening infection of the membranes surrounding the brain and spinal cord. It is caused by the fungus Cryptococcus neoformans, which is found in soil and bird droppings worldwide. Most people with healthy immune systems clear the fungus without symptoms; serious disease is far more common in people whose immunity is compromised, particularly those living with HIV.
Key points
- This fungus occurs naturally in soil and bird droppings, yet only causes serious illness when the immune system is weakened.
- Delayed treatment and lack of antiretroviral therapy both sharply raise the risk of a severe outcome.
- Treatment runs in induction, consolidation, and maintenance phases over several months, and stopping early raises the chance of relapse.
Why it matters
The burden of cryptococcal meningitis is significant where HIV remains prevalent. Patients who are not on antiretroviral therapy, or who present late, face the highest risk of severe disease. Travellers with underlying conditions are not exempt.
How antifungal treatment works
Treatment typically proceeds in phases: an induction phase using high-dose antifungal medicine to clear the infection, followed by a consolidation and then a maintenance phase to prevent relapse. Fluconazole is a cornerstone of the consolidation and maintenance stages, and belongs to the antifungals class of medicines. The full course runs for months; stopping early substantially raises the risk of the infection returning.
Headache, fever, neck stiffness, sensitivity to light, and confusion are warning signs that need urgent medical assessment, do not wait these out.