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Lost voice due to meninges in the brain and advised to go for spinal tap. How serious is my condition?

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Internal Medicine Specialist
Practicing since : 2009
Answered : 2751 Questions
Our 43 yr. old daughter has just been diagnosed with a cryptococcus infection which is serious as it could attack the meninges in the brain. We are 1200 miles away and she is unable to describe this condition verbally because she has lost her voice for several weeks now. Can you tell us how serious this is and what can be done? She mentioned she may need to have a spinal tap to check if infection has gone to the brain. This all just happened in the past hour. Our daughter lives in Wash. D.C. and is being treated at XXXXXXX Washington Hospital.
Posted Thu, 26 Dec 2013 in General Health
Answered by Dr. Anshul Varshney 1 hour later
Brief Answer: Fungal infection usually in immunocompromised Detailed Answer: Dear Sir. We are very sorry to hear this. But I am still not able to understand that without spinal tap qnd CSF examination diagnosis of cryptococcal infection is made on what basis. I mean has it been shown to be present some where? See cryptococcal infection can occur at many places like lungs , skin , meninges. it is a fungal infection and is usually found in immunocompromised people. If in meninges demonstration would be by cryptococcal antigen or indian ink prepration in cerebro spinal fluid. In lungs , X ray may give an idea. See without knowing which part of body it has affected , it would be difficult to comment upon Treatment is with anti fungals. But immunocompromised state is a big challenge. I have tried my best to answer your query with the available information , still if you have any query ask me. Wish your daughter a speedy recovery.
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Follow-up: Lost voice due to meninges in the brain and advised to go for spinal tap. How serious is my condition? 18 hours later
Our daughter has been ill with various infections since last August. She had a surgery to remove a benign tumor on the ovary in July, and this seemed to start it all. She has a diagnosis of asthma, has had sinusitus, and possbile pnemonia which was not confirmed - all happening since last August. She is regularly treated for her JRA, has been on steroids including Prednisone. Her pulmonologist and other specialists at Georgetown Hospital in D.C finally have determined she does have the cryptococcus fungal infection in one lung, the bronchi, and the esophagus. They are doing a spinal tap today (Friday) to see if the infection has spread to the meninges. Her immune system is ALWAYS compromised when she develops other illness or infections. Thanks for your reply and please send any further remarks. Her father will be flying to D.C. from Minnesota in a day or two as soon as we get the results of the spinal tap.
Answered by Dr. Anshul Varshney 11 minutes later
Brief Answer: Pred causes immunosupression, Consider Vasculitis Detailed Answer: I am really sorry to hear about her sufferings. Since she was on Prednisolone (Steroid) , her immune system is already compromised , and she is very prone to fungal infections. She has to be treated intensively at this stage. I suppose her doctors will play there role well , since they are able to diagnose cryptococcal infection. I would like you to discuss possibility of Vasculitis , especially Wegner's Granulomatosis in your daughter , as she has sinusitis , lung involvement , and already diagnosed with JRA. I don't know her kidney status. That is also compromised in many cases of Wegner's. I am not saying she has vasculitis , i just gave it a thought ecause you asked for my remark. I wish her good health. If you don't have further query , you may close the discussion , and rate it.
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