We're going to move into fungal now.
Are you ready?
So let’s talk about this
So here, we’ll get into an
interesting dynamic, right?
We have meninges.
And what does encephalitis mean to you?
Now, your most common patient
who is susceptible to fungal
as you’d expect anywhere
up and down the body
would be in an immunocompromised
For example, what if you have
fungal infection of the esophagus?
What if you find oral thrush?
You take a tongue depressor and you
scrape of the white stuff off the tongue.
Immunocompromised is what
you’re thinking already.
No exception here.
Common organisms include
Your focus, take a look, the letter C.
You could have Aspergillus,
you could have Histoplasma,
you could have blasto,
they’re all here, right?
But your focus will be on
the first two, please.
Let’s talk about cryptococcal
So I'm only going to
focus upon a few here,
the ones that are more common.
Most common, fungal infection of the CNS.
Typically, who’s your patient?
Do not confuse
this with candida.
Well, how is the patient
breathing in or should I say,
what’s the access point?
Maybe inhalation of spores from
soil or maybe your pigeon crap.
In other words, your
pigeon stool or excrement.
So think about all the different
places where pigeons love to play.
Maybe you’re working in an office in
which right outside your window,
every morning, you are breathing
in that lovely pigeon excrement.
Or maybe you are what, living underneath a
bridge because you feel like camping out,
But a homeless person, underneath a tunnel
or whatever, and then what happens?
While, you sleep there, you might
get pooped upon by a pigeon.
Anyhow, the point
Increased intracranial pressure.
And cranial nerve palsies are common
presentations of cryptococcal.
It can have a very bland
Better keep that in mind.
So please look for your
most common fungal CNS
Let’s walk through in greater
detail what you’re going to use.
To diagnose your patient with
in the CSF, you
Very low glucose and
I need you to keep this as
being very important to you
and you go back to that table and I grouped
together viral and I put in fungal.
But here, make sure
that you keep separate
your Cryptococcus because this is
the most common CNS infection.
India ink should come
to mind immediately.
Cryptococcal antigen is highly
sensitive and specific.
Make sure you know what Cryptococcus
looks like, please, in microbiology.
Do that for me now.
Now, what’s interesting about chronic
type of cryptococcal meningitis?
Look where we are, the
Why am I bringing this
to your attention?
In the basal region, what if you were
to then block the outflow of CSF
from the foramen of
Luschka or Magendie?
So now, you’re thinking about
the lateral ventricles.
You know about your ependymal cells.
You’re producing CSF.
You go from your lateral ventricle,
third ventricle, fourth ventricle,
and then you should come out of your
apertures to bathe the spinal cord, right?
But what if you
block that outflow?
And you call this an obstructive,
non-communicating type of hydrocephalus,
So if you’re confused
not to worry, we’ll talk about
that in greater detail.
The antimicrobial therapy
here, amphotericin B.
So let this be a good time for you
to pay attention to some of your
blood brain barrier
type of pharmacology.
Here, we have amphotericin B.
We have others here as well, but for the
most part, focus on amphotericin B.