How is fungal meningitis spread

How many people are at risk in this outbreak? The investigation indicates that there were over 17, vials of this potentially contaminated medication produced. There may be some variability from vial to vial within each batch. It has been estimated that something like 13, people were exposed to this medication; some of it hadn't been used yet by the time the alert went out, and some people received more than one dose. That's very large. If there is a silver lining in this dark cloud, it's that the proportion of people who received this medication who are actually getting sick is rather low.

It looks to be less than 5 percent. What are the symptoms? The symptoms are insidious. They begin slowly and not very dramatically: fever and chills, headache and a stiff neck from the inflammation. People lose their appetite, feel ill, can be nauseated and can vomit. But there's something else that's subtle: It seems these fungi have the capacity to invade little blood vessels in and around the brain, cause bleeding and produce symptoms that mimic a stroke—difficulty speaking, loss of balance and trouble walking.

Those symptoms can occur even without fever, so physicians have to learn that patients who present with stroke symptoms may actually be part of this. Membranes protect the brain and spinal column from harmful particles that might be circulating in the blood. How does the fungus get past the blood—brain barrier? The fungi were inoculated adjacent to this barrier but it is still a bit of a mystery how they were able to translocate from outside the membranes into and beyond the membranes. There are a couple of theories.

One is that the fungi begin to multiply in a secluded space, then they kind of eat their way through the membranes. Another hypothesis is: Could the inoculation have nicked the membrane and provided a microscopic mode of access? Practitioners who perform these procedures say this happens very rarely, but it remains to be seen. People who die of the infection will receive postmortem examinations—autopsies.

Careful study will help us understand what happened in this circumstance and how to prevent this from happening in the future. What treatment options are available? There are two major drugs, called amphotericin B and voriconazole.

Both of those drugs are effective if we get in early. They are given intravenously initially, and then we hope we can transition to oral variations. They have substantial side effects, and we have to walk a kind of tightrope to treat the patient without damaging the kidneys or the liver. This is all new territory for all of us, so we will learn as we go how completely we can treat these patients and how quickly or slowly it takes them to get better.

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Delayed treatment increases the risk of permanent brain damage or death. It's also important to talk to your doctor if a family member or someone you live or work with has meningitis. You may need to take medications to prevent getting the infection. Meningitis is an infection and inflammation of the fluid and three membranes meninges protecting your brain and spinal cord. The tough outer membrane is called the dura mater, and the delicate inner layer is the pia mater.

The middle layer is the arachnoid, a weblike structure containing the fluid and blood vessels covering the surface of the brain. Viral infections are the most common cause of meningitis, followed by bacterial infections and, rarely, fungal and parasitic infections.

Because bacterial infections can be life-threatening, identifying the cause is essential. Bacteria that enter the bloodstream and travel to the brain and spinal cord cause acute bacterial meningitis. But it can also occur when bacteria directly invade the meninges. This may be caused by an ear or sinus infection, a skull fracture, or — rarely — some surgeries. Viral meningitis is usually mild and often clears on its own.

Most cases in the United States are caused by a group of viruses known as enteroviruses, which are most common in late summer and early fall. Viruses such as herpes simplex virus, HIV , mumps virus, West Nile virus and others also can cause viral meningitis. Slow-growing organisms such as fungi and Mycobacterium tuberculosis that invade the membranes and fluid surrounding your brain cause chronic meningitis.

Chronic meningitis develops over two weeks or more. The signs and symptoms of chronic meningitis — headache, fever, vomiting and mental cloudiness — are similar to those of acute meningitis. Fungal meningitis is relatively uncommon in the United States.

It may mimic acute bacterial meningitis. It's often contracted by breathing in fungal spores that may be found in soil, decaying wood and bird droppings.

Fungal meningitis isn't contagious from person to person. Cryptococcal meningitis is a common fungal form of the disease that affects people with immune deficiencies, such as AIDS. It's life-threatening if not treated with an antifungal medication. Even with treatment, fungal meningitis may recur. Parasites can cause a rare type of meningitis called eosinophilic meningitis. Parasitic meningitis can also be caused by a tapeworm infection in the brain cysticercosis or cerebral malaria.

Amoebic meningitis is a rare type that is sometimes contracted through swimming in fresh water and can quickly become life-threatening. The main parasites that cause meningitis typically infect animals. People are usually infected by eating foods contaminated with these parasites. Parasitic meningitis isn't spread between people. Meningitis can also result from noninfectious causes, such as chemical reactions, drug allergies, some types of cancer and inflammatory diseases such as sarcoidosis.

Meningitis complications can be severe.