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Live Imaging of Antifungal Activity by Human Primary Neutrophils and Monocytes in Response to A. fumigatus
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Live Imaging of Antifungal Activity by Human Primary Neutrophils and Monocytes in Response to A. fumigatus

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Fungal meningitis

C B Treseler1, A M Sugar

  • 1Section of Infectious Diseases, Evans Memorial Department of Clinical Research, Boston University Medical Center, Massachusetts.

Infectious Disease Clinics of North America
|December 1, 1990
PubMed

Insights

Fungal meningitis, though often chronic, can be fatal. Pathogenic fungi spread via inhalation or dissemination, affecting the central nervous system (CNS) primarily in immunosuppressed hosts.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Neurology

Background:

  • Fungal meningitis presents as a subacute or chronic condition, potentially as lethal as bacterial meningitis if untreated.
  • Pathogenic fungi share similarities, often initiating infection through inhalation leading to pulmonary disease, followed by potential hematogenous dissemination to the central nervous system (CNS).
  • Immunosuppression is a frequent, though not universal, host factor in fungal meningitis.

Purpose of the Study:

  • To review the pathogenesis, diagnosis, and treatment of fungal meningitis.
  • To highlight the differences in disease presentation between fungal molds and yeasts.
  • To discuss current and emerging antifungal treatment strategies.

Main Methods:

  • Review of existing literature on fungal meningitis.
  • Analysis of pathogenic mechanisms and clinical presentations.
  • Evaluation of diagnostic challenges and therapeutic options.

Main Results:

  • Molds typically cause focal CNS disease with necrosis, while yeasts lead to diffuse inflammation, often at the brain base, causing hydrocephalus.
  • Diagnosis can be challenging, with cerebrospinal fluid (CSF) sometimes showing normal results, negative smears, and sterile cultures.
  • Serological tests and travel history can aid diagnosis, with amphotericin B remaining a primary treatment, and newer azoles showing promise, particularly for cryptococcal meningitis.

Conclusions:

  • Fungal meningitis requires careful diagnosis and management, considering the specific fungal pathogen and host factors.
  • While amphotericin B is standard, newer azole antifungals represent a promising advancement, especially for specific types like cryptococcal meningitis.
  • Further large-scale studies are needed to clarify the role of novel azoles in treating central nervous system mycoses.

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