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Fungal meningitis update

Background

Clinically, meningitis manifests with meningeal symptoms (eg, headache, nuchal rigidity, photophobia), as well as pleocytosis (an increased number of white blood cells) in the cerebrospinal fluid (CSF). Depending on the duration of symptoms, meningitis may be classified as acute or chronic. (See Etiology and Clinical Presentation.)

Fungal meningitis update

Although iatrogenic meningitis has typically been a complication of neurosurgical procedures, an outbreak of fungal meningitis has resulted from epidural injection of a contaminated methylprednisolone solution. The outbreak, which has, at this point, involved 308 cases and 23 deaths in 17 states, originated with preparations from a single compounding pharmacy.^{[1, 2]} Pathogens in these cases have been identified as Exserohilum rostratum (a brown-black mold) and Aspergillus. ^[3]

For empiric antifungal therapy, the Centers for Disease Control (CDC) recommends voriconazole, preferably at a dose of 6 mg/kg every 12 hours, continued for the duration of treatment. Serum voriconazole concentrations should be monitored regularly (eg, weekly), with a target trough level of 2-5 mcg/ml.^[4]

For additional information on the treatment of fungal meningitis, see the discussion of Exserohilum rostratum in Meningitis Treatment.

Continuing updates on fungal infection published by the CDC can be obtained at the CDC Web page Multisite Fungal Meningitis Outbreak Investigation.

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