The frontal plane QRS is the most helpful clue to distinguish between an ostium secundum ASD and an ostium primum ASD. In primum defects left axis deviation is seen in most patients with an axis of > -30 degrees and very few patients have right axis deviation. In contrast ostium secundum defects have an axis between 0 degrees and 180 degrees with most cases to the right of 100 degrees.In the ECG above, you can see an example of the rSR pattern in V1 with a R greater than S with T wave inversion which is commonly seen in volume overload right ventricular hypertrophy. Diagnosis
Classification
A defect in the ostium primum is occasionally classified as an atrial septal defect, but it is more commonly classified as an atrioventricular septal defect. Treatment
Hemodynamically significant ASDs (flow ratio 1.5:1) are large enough to be closed surgically. The long term prognosis is excellent. Pulmonary hypertension with shunt reversal is a contraindication for surgery, however the pulmonary hypertension can frequently be treated with medicines. The hole can then be closed safely with a good long term prognosis. References
Notes

External links

 This article incorporates text available under the CC BY-SA 3.0 license.
People who are at an increased risk of acquiring particular fungal infections in general may also be at an increased risk of developing fungal meningitis, as the infection may in some cases spread to the central nervous system. People residing in the Midwestern United States, and Southwestern United States and Mexico are at an increased risk of infection with Histoplasma and Coccidioides, respectively. Diagnosis
If suspected, fungal meningitis is diagnosed by testing blood and cerebrospinal fluid for pathogens. Identifying the specific pathogen is necessary to determine the proper course of treatment and the prognosis. Measurement of opening  pressure, cell count with differential, glucose and protein concentrations, Grams stain, India ink, and culture tests should be performed on cerebrospinal fluid when fungal meningitis is suspected. Treatment
Fungal meningitis is treated with long courses of high dose antifungal medications. The duration of treatment is dependent upon the causal pathogen and the patients ability to stave off the infection; for patients with a weaker immune system or diabetes, treatment will often take longer. Prognosis
Prognosis depends on the pathogen responsible for the infection and risk group. Overall mortality for Candida meningitis is 10-20%, 31% for patients with HIV, and 11% in neurosurgical cases (when treated). Prognosis for Aspergillus and coccidioidal infections is poor. Outbreaks
As of November 5, 2012, the CDC reported that 409 patients had laboratory-confirmed fungal meningitis caused by injections with contaminated medication. There had been 30 fatalities. A black mold, Exserohilum rostratum, was found in 45 of these cases.