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Fungal infections of the central nervous system
1Neurology Service, Veterans Affairs Medical Center, Albuquerque, New Mexico 87108, USA.
Abstract:
This review discusses a practical approach to the patient with possible fungal infection of the central nervous system (CNS). Difficulties in establishing the diagnosis come from the nonspecific clinical syndromes (subacute meningitis, meningoencephalitis, and brain abscess) and the low isolation rate of fungi from cerebrospinal fluid (CSF). Helpful diagnostic clues often come from knowledge of the patient's geographic travels, risk factors, evidence of systemic organ infection, and fungal serologic tests. Standard and new antifungal agents are evaluated and the initial and suppressive drug management of the common fungal infections is presented.
Insights
Diagnosing central nervous system (CNS) fungal infections is challenging due to vague symptoms and low fungal detection rates in cerebrospinal fluid (CSF). This review offers a practical diagnostic and management strategy for clinicians.
Area of Science:
- Neurology
- Infectious Diseases
- Mycology
Background:
- Fungal infections of the central nervous system (CNS) present with nonspecific clinical syndromes like meningitis, meningoencephalitis, and brain abscess.
- Diagnosis is often hindered by low fungal isolation rates from cerebrospinal fluid (CSF).
Purpose of the Study:
- To present a practical approach for diagnosing and managing CNS fungal infections.
- To review diagnostic clues and evaluate antifungal agents for CNS mycoses.
Main Methods:
- Review of clinical presentations, diagnostic challenges, and epidemiological factors.
- Evaluation of current and novel antifungal therapies.
- Discussion of initial and suppressive drug management strategies.
Main Results:
- Diagnostic clues include patient history (geographic travel, risk factors), systemic involvement, and serologic tests.
- Various standard and emerging antifungal agents are available for treatment.
- Management involves both initial treatment and long-term suppressive therapy.
Conclusions:
- A systematic approach integrating clinical data, risk factors, and diagnostic tests is crucial for CNS fungal infections.
- Appropriate selection and administration of antifungal agents are key to successful patient outcomes.