Saving the life of a man with critical meningitis caused by a rare fungal infection

On May 16, the Central Hospital for Tropical Diseases informed that the hospital's doctors had just saved the life of a patient with critical fungal meningitis in a person with alcoholic cirrhosis.

Patient V.D.P., 42 years old from Ha Tinh, was admitted to the hospital in critical condition. The patient had symptoms of severe headache, vomiting, prolonged high fever and impaired consciousness. The patient's condition was very serious, life-threatening due to the risk of deep coma, and may require a ventilator to support breathing.

According to the patient’s family, he had a history of alcoholism. About two weeks before being admitted to the hospital, he had a persistent headache, a gradually increasing fever, and severe vomiting of unknown cause. Before that, he had been drinking and addicted to alcohol for many years, but no underlying medical condition had been discovered.

The patient was examined and admitted to a provincial hospital, diagnosed with bacterial meningitis and treated with antibiotics. However, after a week, the condition did not improve but worsened: continuous fever of 39-40°C, severe headache and gradually becoming lethargic.

The patient was transferred to the Emergency Department (Central Hospital for Tropical Diseases). Here, the patient was given a comprehensive examination, a lumbar puncture, and specialized tests. The results of the lumbar puncture (lumbar puncture) staining with ink detected Cryptococcus infection - the cause of meningitis. At the same time, the doctors noted that the patient had signs of progressive cirrhosis such as jaundice, ascites, etc., and a severely weakened immune system.

Master Nguyen Kim Anh - Emergency Department said that fungal meningitis is a rare but very dangerous disease, progressing silently and can suddenly threaten life, especially in people with weakened immune systems such as cirrhosis, HIV, diabetes or kidney failure. For the above patient, the main risk factor is alcoholic cirrhosis. Immediately after identifying the causative agent, the patient is treated with specific antifungal drugs and closely monitored.

According to Dr. Kim Anh, fungal meningitis is a challenge to treat because current antifungal drugs penetrate the blood-brain barrier at a very low rate, only about 1-2%, making the prognosis often serious even when the cause is correctly diagnosed. Fortunately, after 10 days of intensive treatment, the patient was completely alert, no fever and headache reduced - a rare recovery progress in severe cases of fungal meningitis.

Currently, Cryptococcus fungus is present in the natural environment but is most commonly found in soil, water contaminated with pigeon droppings or in moldy environments. Healthy people are usually not affected because the immune system is able to control it. In the above case, the patient had a risk factor due to frequent exposure to a livestock environment with many pigeons - a common source of infection for this fungus.

However, not everyone who comes into contact with pigeons gets sick. Cryptococcus fungus only causes disease when the immune system is weakened, often found in people with cirrhosis, HIV/AIDS, chronic diseases or those taking immunosuppressants. In addition, inflammatory indicators in the blood are often not significantly increased, making the disease easily confused with other causes if a detailed cerebrospinal fluid test is not performed. Meanwhile, fungal meningitis has a high mortality rate if not diagnosed and treated promptly.

Dr. Kim Anh warns that people with symptoms of prolonged headache, persistent fever, vomiting or impaired consciousness, especially if they have underlying diseases, need to go to a specialized medical facility for accurate diagnosis and timely treatment. If fungal meningitis is detected early and treated promptly, the prognosis will be better. On the contrary, if delayed, the patient may face a high risk of death. Worryingly, the initial symptoms can easily be confused with the flu or tuberculosis.

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