Fungal Meningitis: Symptoms, Causes, and Treatment
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is fungal meningitis?
Fungal meningitis is a fungal infection that causes inflammation around the brain and spinal cord, most often in people with weakened immune systems, and it can be fatal. It is not contagious. Symptoms include headache, stiff neck, confusion and light sensitivity. It is treated in hospital with IV antifungals. Seek emergency care for confusion, severe headache or stiff neck. [3]
What the research says
Cryptococcal meningitis is a major cause of HIV-related death. An analysis estimated 223,100 cases of cryptococcal meningitis worldwide in 2014 and 181,100 deaths. About 73% of cases were in sub-Saharan Africa, and cryptococcal meningitis was responsible for 15% of AIDS-related deaths (Rajasingham et al., Lancet Infectious Diseases, 2017).
A single high dose of liposomal amphotericin B worked as well as the standard regimen. In a trial of 844 adults with HIV-associated cryptococcal meningitis in five African countries, 24.8% of those given a single high dose of liposomal amphotericin B (plus flucytosine and fluconazole) had died at 10 weeks, compared with 28.7% on the WHO-recommended regimen. The new regimen was non-inferior and caused fewer serious (grade 3 or 4) adverse events, 50.0% versus 62.3% (Jarvis et al., New England Journal of Medicine, 2022).
Understanding Fungal Meningitis
Fungal meningitis is a fungal infection that causes inflammation around your brain and spinal cord. It can happen if you have a weakened or suppressed immune system. Many types of fungus can cause it. Some you breathe in from the soil around you, and others naturally live on your skin and can sometimes grow out of control [3].
Meningitis can be fatal. Go to an emergency room if you have symptoms like confusion, severe headache or a stiff neck [3].
Feature | Description |
|---|---|
What is affected | The coverings around the brain and spinal cord |
Contagious? | No |
Severity | Can be fatal; needs emergency care |
Common fungi | Cryptococcus, Blastomyces, Candida, Coccidioides, Histoplasma |
Symptoms and Identifying Signs
Fungal meningitis symptoms can affect your thinking, vision and how you feel overall. They may come on slowly, over days or weeks [3]:
Symptom group | Common signs |
|---|---|
Physical | Headache, stiff neck, nausea or vomiting |
Thinking and mental state | Confusion or mental changes, seizures |
Vision and light | Double vision, drooping eyelid, sensitivity to light |
Causes and Pathogens
Fungal meningitis can happen when a fungal infection travels from one part of your body to your brain or spinal cord. Cryptococcus (C. neoformans and C. gattii) is the most common cause in people with a compromised immune system [3].
Blastomyces, Coccidioides and Histoplasma: most of these fungi live in the soil in different parts of the U.S. and infect you when you breathe them in. Most people who get infected this way have a weakened immune system.
Candida: it naturally lives on your body, and an infection inside the body can sometimes spread to the brain and spinal cord.
Surgery or hospital stays: rarely, a fungal infection can be acquired this way.
Risk Factors
You are at higher risk if you have a weakened immune system. This includes preterm infants and people who [3]:
Have HIV
Have cancer
Take certain medicines for an autoimmune disease
How Fungal Meningitis Is Diagnosed
Healthcare providers diagnose fungal meningitis by testing your blood and spinal fluid (lumbar puncture), which helps determine the cause of the swelling and how to treat it. They also usually get images of the inside of your head, such as a CT scan or MRI [3].
Test | Purpose |
|---|---|
Lumbar puncture (spinal tap) | Tests spinal fluid to find the cause of the inflammation |
Blood tests | Help determine the cause of the swelling and how to treat it |
CT scan or MRI | Images of the inside of the head |
Treatment and Management
Providers treat fungal meningitis with antifungal medicines given directly into a vein (IV) in the hospital. Corticosteroids are not routinely used for cryptococcal meningitis, the most common type, because a large trial found they did more harm than good [3].
You may need antifungal medicines for weeks or months to fully clear the infection, with hospital treatment for at least some of that time. If you have HIV, your provider may need to adjust your antiretroviral treatment [3].
Outlook and Prevention
Yes, you can recover from fungal meningitis. Symptoms can sometimes come back after treatment, especially if you have a weakened immune system. Survival rates vary by the type of fungal infection, where you live and whether your immune system is weakened. Experts estimate about 80% survival for people with HIV and Cryptococcus meningitis in North America with treatment, but around 30% in parts of Africa, partly because of differences in the healthcare available [3].
If you have a weakened immune system, you can take steps to lower your risk [3]:
Avoid areas that expose you to dirt or dust.
Stay inside with windows closed during dust storms.
Run HEPA filters in your home.
Wear an N95 respirator during gardening, digging or other yard work.
Ask about testing and prevention: if your provider recommends it, get tested and treated for fungal infections before starting HIV treatment, or take antifungal treatment if your risk is high.
Conclusion
Fungal meningitis is a serious condition that needs urgent medical care. It isn't contagious, but it can be fatal and mostly affects people with weakened immune systems. Knowing the symptoms and reducing exposure to dust and soil are the first steps in protecting your health [3].
Your next step: if you or someone you care for has confusion, a severe headache or a stiff neck, go to an emergency room. If your immune system is weakened, talk to your provider about how to prevent infections.
Frequently Asked Questions
What exactly is fungal meningitis?
Fungal meningitis is a fungal infection that causes inflammation around the brain and spinal cord. It can happen when a fungal infection travels from another part of the body to the brain or spinal cord, and it is most likely in people with a weakened immune system. It can be fatal, so it needs urgent medical care. [3]
Is fungal meningitis contagious?
No, fungal meningitis isn't contagious. Some fungi that can lead to meningitis, such as Candida, can spread from person to person, but a fungal infection doesn't always cause meningitis. [3]
Who is at the highest risk for fungal meningitis?
People with a weakened immune system, including people who have HIV, have cancer, take certain medicines for an autoimmune disease, and preterm infants. [3]
What are the first signs of fungal meningitis?
Symptoms may come on slowly, over days or weeks. They include headache, stiff neck, nausea or vomiting, confusion or mental changes, double vision, a drooping eyelid, sensitivity to light and seizures. Go to an emergency room for confusion, severe headache or stiff neck. [3]
How is fungal meningitis diagnosed?
Providers test your blood and spinal fluid (lumbar puncture) to find the cause and decide on treatment. They usually also get images of the head, such as a CT scan or MRI. [3]
Can fungal meningitis be cured?
You can recover, but you may need antifungal medicines for weeks or months to fully clear the infection, with hospital treatment for at least some of that time. Symptoms can come back after treatment, especially with a weakened immune system. [3]
What fungi most commonly cause this infection?
Cryptococcus is the most common cause in people with a compromised immune system. Others include Blastomyces, Candida, Coccidioides and Histoplasma. Most of these live in soil and infect you when you breathe them in. [3]
What is the survival rate for fungal meningitis?
The survival rate for fungal meningitis varies by the type of fungal infection, where you live and whether your immune system is weakened. Experts estimate about 80% survival for people with HIV and Cryptococcus meningitis in North America with treatment, but around 30% in parts of Africa. [3]
How can I prevent fungal meningitis?
If your immune system is weakened, avoid areas with dirt or dust, stay inside with windows closed during dust storms, run HEPA filters at home and wear an N95 respirator during gardening, digging or yard work. Your provider may also recommend antifungal prevention if your risk is high. [3]
References
Rajasingham R, Smith RM, Park BJ, et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infectious Diseases. 2017;17(8):873-881. PMID 28483415. https://doi.org/10.1016/S1473-3099(17)30243-8
Jarvis JN, Lawrence DS, Meya DB, et al. Single-dose liposomal amphotericin B treatment for cryptococcal meningitis. New England Journal of Medicine. 2022;386(12):1109-1120. PMID 35320642. https://doi.org/10.1056/NEJMoa2111904
Cleveland Clinic. Fungal meningitis. Cleveland Clinic. August 12, 2025. https://my.clevelandclinic.org/health/diseases/fungal-meningitis
Medical disclaimer
This article was prepared for general information only and is not a substitute for professional medical advice.
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