Meningitis in Children - I.V. Bogadelnikov 2005

Aseptic Meningitis in Children. General Information
Aseptic Meningitis of Fungal Etiology
Mixed Bacterial-Fungal Meningitis in Children

The ubiquitous occurrence of Fungi in nature and the high incidence of Secondary Immunodeficiency States accompanied by impaired antifungal defense mechanisms explain the frequent development of Fungal infections in children. Currently, primary fungal infections, including those of the CNS presenting as meningitis and meningoencephalitis, are well recognized. However, The Development of secondary CNS mycoses occurring against the Background of bacterial Purulent meningitis poses significant challenges for both Diagnosis and Treatment. An Analysis of the clinical course and outcomes of bacterial-fungal meningoencephalitis in children aged 1 to 5 years led to the following Conclusions (M.N. Sorokina et al., 2000).

1. Clinical criteria for fungal meningoencephalitis in children with acute neuroinfections include: a second wave of clinical deterioration (most commonly on days 9–12 of the disease), and progressive symptoms of intracranial Hypertension and Hydrocephalus despite the initial efficacy of antibiotic therapy;

a prolonged, intermittent course of meningoencephalitis and increasing protein-Cell dissociation in the CSF. An indirect indicator of fungal CNS involvement is a positive response to Diflucan, which becomes clinically apparent as early as days 3–5.

2. Definitive diagnostic signs of mycosis include positive fungal cultures isolated from the CSF, Blood, urine, and stool, as well as diagnostic antibody and antigen titers in the CSF and blood.

3. Monitoring via NSG (neurosonography), as well as CT (computed tomography) and MRI (Magnetic Resonance imaging) data, has significant diagnostic value for assessing the developmental dynamics of bacterial-fungal meningoencephalitis, as they allow for the detection of structural Brain tissue abnormalities, enabling the development of rehabilitation therapy standards for these patients.

4. The treatment strategy for bacterial purulent meningitis includes: adequate antibiotic therapy in the acute phase; and, in cases of a prolonged and complicated course with laboratory confirmation of mixed bacterial-fungal meningoencephalitis, combined therapy with an antibiotic and Diflucan. If the latter is insufficiently effective, Fungizone can be administered parenterally through an Ommaya reservoir.