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93: CRYPTOCOCCAL MENINGITIS

Mollie Venglar, DSc, MSPT, NCS; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYM

  • Meningitis

ICD-9-CM CODE

  • 321.0 Cryptococcal meningitis

ICD-10-CM CODE

  • B45.1 Cerebral cryptococcosis

PREFERRED PRACTICE PATTERNS1

  • 5A: Primary Prevention/Risk reduction for Loss of Balance and Falling

  • 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System— Congenital Origin or Acquired in Infancy or Childhood

  • 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—Acquired in Adolescence or Adulthood

  • 5I: Impaired Arousal, Range of Motion, and Motor Control Associated with Coma, Near Coma, or Vegetative State

PATIENT PRESENTATION

After returning from a mission trip to promote farming in rural areas of Africa, a 28-year-old man noted increasing stiffness in his neck and headaches that responded poorly to acetaminophen and rest. He had little appetite and felt feverish after a couple of days. His friends noticed he seemed to be progressively more confused and took him to the doctor. Meningitis was suspected so the man was sent to the emergency department of the local hospital. Lumbar puncture revealed normal glucose and protein levels but elevated lymphocytes in the cerebrospinal fluid.

KEY FEATURES

Description

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

  • Fungus Cryptococcus neoformans is found in the soil.

Essentials of Diagnosis

  • Severity and extent of the infection causes a wide range of neurologic signs and symptoms, generally nonfocal in nature.

  • Different from 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.

  • 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.

FIGURE 93-1

India ink preparation. Cryptococcus neoformans seen as encapsulated yeast on India ink preparation of the CSF from an HIV patient with cryptococcal meningitis. (From Knoop KJ, Stack LB, Storrow AB, Thurman RJ. The Atlas of Emergency Medicine. 3rd ed. Photo contributor: Seth W. Wright, MD. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 93-2

Cryptococcal infection. This patient had extensive cutaneous involvement with disseminated cryptococcal infection. (From Knoop KJ, Stack LB, Storrow AB, Thurman RJ. The Atlas of Emergency Medicine. 3rd ed. Photo contributors: Seth W. Wright, MD, and Universidad Peruana Cayetano Heredia, Lima, Peru. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

  • If a central nervous system infection is suspected, the therapist should seek ...

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