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  • Meningitis

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  • 321.0 Cryptococcal meningitis

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  • B45.1 Cerebral cryptococcosis

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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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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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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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Diagnostic Procedures

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  • Lumbar puncture to test the cerebral spinal fluid for presence of red and white blood cells, protein concentration, glucose, and microorganisms
    • High polymorphonuclear leukocytes, high protein, low glucose suggests bacterial infection
    • Predominant lymphocytes, high protein, low glucose suggests ...

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