The Clinical And Etiology Diagnosis Of Fungal Meningitis

Objective: The incidence of fungal meningitis has increased in recent years. Some factors have contributed to this increase, included the use of corticosteroids in autoimmune diseases, the long-term use of immunosuppressants after organ transplantation, and the increasing prevalence of AIDS. In China, cryptococcal meningitis is the main fungal infective disease in central nervous system. The diagnosis of cryptococcal mentingitis is specific. But the diagnosis of other rare fungal is still difficult. We should improve the recognization on them and investigate the early diagnosis method and effective treatment.The research was designed to discuss the clinical and etiology of two rare fungal meningitis. Then we could get some useful informations for diagnosis and therapy of fungal meningitis in future.Methods: One fusarium meningitis patient was from department of neurology of the second hospital of Hebei Medical University in may 2010. The other was from department of neurology of norman bethune international peace hospital in feberary 2007. He was diagnosed as rhinocerebral mucormycosis.The fusarium meningitis patient was the main subject. He was undertaken the routine test and CSF cytologic(CSFC) examinations, including CSFC May-Grunwald-Giemsa(MGG) staining, CSFC alcian blue staining, India ink staining in different periods. The CSF culture yielded Fusarium spp.. The pathogen was observed by microscope, scanning electron microscope(SEM) and transmission electron microscope(TEM).The CSF of rhinocerebral mucormycosis patient, which was examined in our laboratory, was observed for CSFC. Results:1 Fusarium meningitis1.1 CSF routine testThe CSF was clear and colorless. The number of the white blood cell and the content of protein were related with the patient's condition. They got higher as the illness got worse. After the treatment, they decreased by degrees.1.2 CSFC examinationsThe lymphocytes were in the superiority early. When the illness got worse, the neutrophilic granulocytes increased even exceeded 50%. After the treatment, the proportion of lymphocytes increased again.1.3 The test of etiologyThe patient was detected cerebrospinal fluid cytology (including MGG stain, alcian blue stain and centrifugation ink stain), all are negative. The CSF culture yielded fusarium. The test ofβ-(1→3)-D-glucan in CSF was positive.1.4 Past medical historyThere was no past history of hematologic disease, immunodeficiency disease, diabetes and so on. But he had contacted with bird species, dogs, and crops.1.5 SEM observationSpores were existed around hyphae. They had different shapes, such as clavated, round. Hyphae were branching, thick or thin. There were some folds on the surface.1.6 TEM observationThe cell walls were differ in thickness. The edges were clear. The structure of cytomembrane inside the cell walls were not well organized. The nucleus was unseen. There were lots of ribosomes, some bladders and membrane structures with low electron density, and transparency cavitations in different size.2 Rhinocerebral mucormycosisThe patient was also detected cerebrospinal fluid cytology. We could see mixed responses in MGG stain. The neutrophilic granulocytes were the main cells. Alcian blue stain and centrifugation ink stain were both negative. Conclusions:1 The incidence of fungal meningitis has risen year after year, especially the rare fungal. We should pay attention to it. Fungal meningitis has high misdiagnosis rate and case fatality rate, so it important to get early diagnosis and effective treatment.2 The CSFC examination is useful to the normal pathogen. Some rare pathogens couldn't be found by MGG stain. The CSF culture and G-test are predictive for the diagnosis.3 The patients who's immune function is low are susceptibility to be troubled with fungal meningitis, so patients who have underlying diseases if their clinical manifestations are similar to meningitis should be highly vigilant against the disease.4 Fungi identification relies on the morphology. The development of electron microscopy provides more evidence for identification.