Fungal encephalitis

Encephalitis an inflammation of the brain parenchyma, presents as diffuse and/or focal

neuropsychological dysfunction. Although it primarily involve the brain, the meninges are
frequently involved (meningoencephalitis.)

Fungal infection of the central nervous system occur rarely in healthy people. The study
conducted by Shrestha and Denning,2015 on burden of serious fungal infection on Nepal
shows that Cryptococci meningitis was found in 164 cases(0.6%). Among them 109 cases
are HIV/AIDS. The presentation of fungal encephalitis is related to geographic area and
compromised immune system.

Common fungi found around the world that can infect CNS.
Cryptococcus neoformans (most common)
Histoplasma capsulatum
Aspergillus (vascular changes)
Candida albicans
Coccidioides immitis (found in soil in central California, Northen Mexico, Area of
Argentina)
Pathophysiology

Fungal spore enter the body via

Initially infect the lung

In some case, fungi may enter the blood stream

If fungemia overcomes the person’s immune

system

The fungus may spread to

CNS

The initial presentation is meningitis, followed by encephalitis and brain

abscess

In addition to infecting the brain, the fungi may infect spinal cord producing an abscess

Abscess will produce symptoms of spinal cord

compression
Clinical manifestation
 Fever
 Malaise
 Headache
 Nuchal rigidity
 Lethargy
 Change in mental status
 Symptoms of increased ICP
Diagnosis
Diagnostic occur challenges because presentation is like other cause of encephalitis
 History of:
 Symptoms develop over a 2 weeks of period.
 Presence of a compromised immune system, history of living
 Travelling specific geographic area
 Increased WBC
 Serologic test: fungal antibody in serum
 Cerebrospinal fluid: increased WBC, Protein
 CSF culture is positive for other fungi
 Neuroimaging: CNS changes related to fungal infection ( CT Scanning, MRI)
 EEG

Medical management
 Medical management is directed by causative fungus and neurologic consequences
 Controlled increased intra cranial pressure.
 Amphotericin B( standard antifungal)
 Fluconazole
 Controlled seizure
Nursing management

1. Nursing assessment aimed at early identification of increased ICP

 Headache
 Blurred vision
 Feeling less alert than usual ( Glasgow coma scale)
 Nausea
 Vomiting
 Increased blood pressure
 Confusion
2. Providing support will assist the patient and family to cope the illness.
3. Work up of patient for immunodeficiency disease
4. Comfort may be optimized by administering non opoid analgesic, limiting
environmental stimuli, positioning
Prevention

No specific activities are known to cause fungal meningitis. People with weak immune
systems should try to avoid

 Large amounts of bird or bat droppings

 Digging in soil
 Dusty activities