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Condition/Disorder Synonym

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  • Meningitis

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ICD-9-CM Code

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  • 321.0 Cryptococcal meningitis

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ICD-10-CM Code

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  • B45.1 Cerebral cryptococcosis

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Preferred Practice Patterns1

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Key Features

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Description

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  • Fungal infection of the meninges of the brain and spinal cord

  • Fungus Cryptococcus neoformans is found in the soil

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Essentials of Diagnosis

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  • Severity and extent of the infection causes a wide range of neurologic signs and symptoms, generally non-focal in nature

  • Different than bacterial meningitis as symptoms emerge over a few days

  • No physical test distinguishes a bacterial from a viral infection; must rely on body fluid cultures

  • Commonly nosocomial or iatrogenic

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General Considerations

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  • If a central nervous system infection is suspected, the therapist should seek information regarding a potential source of infection or a condition that predisposed the patient to infection

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Demographics

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  • Individuals with weak immune systems

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Clinical Findings

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Signs and Symptoms

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  • Symptoms emerge over a few days

  • Hallucinations

  • Nausea

  • Sensitivity to light

  • Headache, stiff neck

  • Change in mental status (confusion, delirium)

  • Fever or hypothermia

  • Increased heart rate

  • Malaise

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Functional Implications

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  • Loss of mobility temporarily with permanent loss possible

  • Loss of hearing/vestibular function in some cases

  • Temporary loss of coordination (fine and gross motor) with permanent loss possible

  • Loss of independence with activities of daily living

  • Reduced cognitive function, particularly executive functions

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Possible Contributing Causes

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  • Contact with fungus Cryptococcus neoformans in the soil

  • Severe sinus infection

  • Cranial or spinal surgery

  • Shunt placement

  • Open head injury

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Differential Diagnosis

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  • Extrapyramidal rigidity

  • Hydrocephalus

  • Alcohol intoxication or withdrawal

  • Hepatic encephalopathy

  • Subarachnoid hemorrhage

  • Meningoencephalitis

  • Epstein-Barr virus

  • Behçet's disease

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • Cryptococcal antigen in CSF or blood

  • Lab tests for complete blood count

  • General chemistry panel and culture are used to determine the microorganism involved and the extent of the infection

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Imaging

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  • Computed tomography (CT) scan for detailed imaging

  • MRI with gadolinium enhancement

  • Electroencephalogram (EEG) may be helpful for patients with seizure due to infection

  • Chest radiographs to disclose area of abscess that may be the original site of infection

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