Symptoms range from fever, nausea, and stiff neck to vision changes, seizures, and even death.
Treatment involves the aggressive use of antifungal drugs to dump the infection and alleviate symptoms.
Oleg Breslavtsev / Getty Images
Cryptococcal Meningitis Contagiousness and Fungus Sources
Cryptococcal meningitis is primarily caused byC.
Oleg Breslavtsev / Getty Images
neoformans.In its yeast statewhen the fungus is actively growing and producing budsC.
neoformansis found mainly in soil and bird droppings (such as from pigeons or chickens).
The buds, in turn, produce tiny spores that can become airborne and be inhaled.
Symptoms include coughing, shortness of breath, chest pain, and fever.
If not recognized and treated,C.
neoformanscan disseminate (spread) into the bloodstream and establish an infection in themeninges, causinginflammationreferred to asmeningitis.
At this stage, the risk of death is significantly increased even with treatment.
In sub-Saharan Africa,C.
gattiiis the primary cause of cryptococcosis.
That said,C.
Although the rate of infection remains low, the fungus’s appearance in North America concerns public health officials.C.
gattiiis known to cause disease in people with intact immune systems, not just in immunocompromised people.
gattiihave been seen as far south as Southern California, primarily among people with HIV/AIDS.
Who Is More Likely to Acquire Cryptococcal Meningitis?
Cryptococcal meningitis, whether byC.
gattii, predominantly affects immunocompromised people.
In those who develop symptoms, the infection is generallysubacute.
This means that the symptoms are less profound and, therefore, more easily dismissed or ignored.
For this reason, many people with HIV will only experience illness whenC.
neoformanshas disseminated and causes meningitis ormeningoencephalitis(inflammation of the meninges and brain).
The people most likely to experience this are those with a severely suppressed immune system.
As a disseminated infection, additional symptoms can develop if other organ systems are affected.
Because cryptococcal meningitis can sometimes be the first symptom of HIV,the diagnostic process can take time.
The sample is then sent to the lab to check for signs ofC.
You will need immediate, urgent treatment with a combination ofantifungal drugswith strong action againstC.
The primary treatment will take several months to complete.
The treatment of cryptococcal meningitis consists of three phases: the induction, consolidation, and maintenance phases.
Treatment is done in a hospital.
At Home
Theconsolidation phasestarts immediately upon your release from the hospital.
After two to four weeks,antiretroviral therapywill be started if you have HIV ortest positive for HIV.
This may take far longer than eight weeks.
Ongoing Maintenance Therapy
Once sterilization is achieved, themaintenance phasebegins.
This involves taking a daily dose of fluconazole to prevent you from gettingC.
neoformansor any other opportunistic fungal infection.
Once these goals are met, maintenance therapy can be stopped.
Can Cryptococcosis Be Cured?
With appropriate treatment, cryptococcal meningitis can be cured.
Without the means to stop the disease from spreading, cryptococcus meningitis is invariably fatal if left untreated.
This can lead to irreversible and potentially devastating complications like:
What Is the Risk of Death?
Even with treatment, cryptococcal meningitis carries a high risk of death.
IRIS occurs in people with very low CD4 counts who suddenly start antiretroviral therapy.
Freed of the burden of HIV, the immune system can sometimes overreact to an organism likeC.
neoformansand launch a potentially deadly, whole-body inflammatory assault.
To reduce the risk, health experts recommend starting antiretroviral therapy four to six weeks after antifungal therapy.
Your immune system is less likely to overreact if there are fewer fungi in your blood.
The sooner you start therapy, the lower your risk of this and other opportunistic infections.
If you don’t know your HIV status, there is no better time than now to get tested.
The treatment involves the aggressive use of antifungal drugs, delivered first in hospital and later at home.
If HIV is involved, antiretroviral therapy would also be started.
2019;10(5):e02193-19.
In:Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV.
Bethesda, MD: National Institutes of Health; 2024. doi10.7759/cureus.9006
MedlinePlus.Meningitis - cryptococcal.
doi:10.12659/AJCR.924410
Johns Hopkins Medicine.Lumbar puncture (LP).
Chemoprophylaxis to prevent first episode of opportunistic disease.
In:Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV.
Bethesda, MD: National Institutes of Health; 2024. doi:10.1097/MAO.0000000000002242
World Health Organisation.Meningitis.
2023;10(5):e295-e307.
doi:10.1001/jamanetworkopen.2020.7954
Centers for Disease Control and Prevention.Reducing your risk of cryptococcosis.
U.S. Preventative Services Task Force.Final recommendation; human immunodeficiency virus (HIV) screening.
