Microcheck 264

Fungi rarely invade the CNS of healthy people, but even common soil fungi are a serious threat to individuals with diabetes, cancer, or immunodeficiency. Cryptococcal meningoencephalitis occurs rarely

684 Chapter 26 Nervous System Infections

Table 26.9 Cryptococcal Meningoencephalitis

Symptoms

Headache, vomiting, confusion, and weight loss; slight or no fever; symptoms may progress to seizures, paralysis, coma, and death

Incubation period

Widely variable, few to many weeks

Causative agent

Filobasidiella (Cryptococcus) neoformans, an encapsulated yeast

Pathogenesis

Infection starts in lung; encapsulated organisms multiply, enter bloodstream, and are carried to various parts of the body; phagocytosis inhibited and opsonins neutralized; meninges and adjacent brain tissue become infected

Epidemiology

Inhalation of dust containing dried pigeon droppings contaminated with the fungus; most people resistant to the disease

Prevention and treatment

No preventive measures.Treatment: amphotericin B with flucytosine or itraconazole

in healthy people, but it is among the leading life-threatening complications in AIDS. The causative organism is a small yeast with a large capsule, often found in soil contaminated with pigeon droppings.

■ What underlying condition should one immediately suspect when confronted with a patient with cryptococcal meningoencephalitis?

■ Why might it be a good idea for persons with immunodeficiency to avoid soil contaminated with pigeon droppings?

■ Why is it so difficult to cure AIDS victims of cryptococcal meningoencephalitis?

figure 12.9). It is one of only a few free-living protozoa pathogenic for humans. In contrast, African sleeping sickness is a quite different protozoan disease. ■ protozoa, p. 304

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