Fungal meningitis refers to meningitis caused by a fungal infection. Signs and symptoms
Symptoms of fungal meningitis are generally similar to those of other types of meningitis, and include: a fever, stiff neck, severe headache, photophobia (sensitivity to light), nausea and vomiting, and altered mental status (drowsiness or confusion). Causes
Fungal meningitis may be caused by the following (and also other) types of fungi:
Candida - C. albicans is the most common Candida species that causes infections of the central nervous system. Coccidioides - it is endemic to southwestern United States and Mexico. A third of patients presenting with disseminated coccidioidomycosis have developed meningitis. Histoplasma - occurs in bird and bat droppings and is endemic to parts of the United States, South, and Central America. Involvement of the central nervous system occurs in about 10-20% of cases of disseminated histoplasmosis. Blastomyces - occurs in soil rich in decaying organic matter in the Midwest United States. Meningitis is an unusual manifestation of blastomycosis and can be very difficult to diagnose. Cryptococcus (Cryptococcal meningitis) - it is thought to be acquired through inhalation of soil contaminated with bird droppings. C. neoformans is the most common pathogen to cause fungal meningitis. Aspergillus - Aspergillus infections account for 5% of fungal infections involving the central nervous system. Risk factors
Individuals with a weak immune system are most at risk. This includes individuals taking immunosuppressive medication, cancer patients, HIV patients, premature babies with very low birth weight, the elderly, etc.
Boutonniere deformity is a deformed position of the fingers or toes, in which the joint nearest the knuckle (the proximal interphalangeal joint, or PIP) is permanently bent toward the palm while the farthest joint (the distal interphalangeal joint, or DIP) is bent back away (PIP flexion with DIP hyperextension). Causes include injury, inflammatory conditions like rheumatoid arthritis, and genetic conditions like Ehlers-Danlos syndrome. Pathophysiology
This flexion deformity of the proximal interphalangeal joint is due to interruption of the central slip of the extensor tendon such that the lateral slips separate and the head of the proximal phalanx pops through the gap like a finger through a button hole (thus the name, from French boutonnière "button hole"). The distal joint is subsequently drawn into hyperextension because the two peripheral slips of the extensor tendon are stretched by the head of the proximal phalanx (note that the two peripheral slips are inserted into the distal phalanx, while the proximal slip is inserted into the middle phalanx). This deformity makes it difficult or impossible to extend the proximal interphalangeal joint. Diagnosis
Stages
Mild extension lag, passively correctable
Moderate extension lag, passively correctable
Mild flexion contracture
Advanced flexion contractureHigher numbers indicate a more severe problem and greater likelihood of a poor outcome. Treatment
Usually treated with a splint placing the proximal interphalangeal joint in extension for 4–6 weeks. Occasionally surgery is needed when splinting is unsuccessful. See also
Swan neck deformity
Z-deformity

References
Further reading
Coons, Matthew S.; Green, Steven M. (August 1995). "Boutonniere deformity". Hand Clinics. 11 (3): 387–402. doi:10.1016/S0749-0712(21)00060-3. PMID 7559817. Souter, William A. (October 1974).