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Fungal central nervous system infections: prevalence and diagnosis

Irene S Kourbeti1, Eleftherios Mylonakis

  • 1Infectious Disease Division, Alpert Medical School and Brown University, Rhode Island Hospital, RI, USA.

Expert Review of Anti-Infective Therapy
|January 8, 2014
PubMed

Insights

Fungal central nervous system (CNS) infections are rare but challenging, affecting diverse hosts. This review details diagnosis and management, highlighting common pathogens like Cryptococcus and Aspergillus.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Mycology

Background:

  • Fungal infections of the central nervous system (CNS) are uncommon but serious, affecting both immunocompromised and immunocompetent individuals.
  • Patients with neurosurgical procedures or CNS devices are at increased risk.
  • Cryptococcus neoformans and Aspergillus spp. are the most frequent causative agents.

Purpose of the Study:

  • To provide an overview of the differential diagnosis of fungal CNS disease.
  • To suggest optimal diagnostic techniques based on host and clinical presentation.
  • To summarize emerging pathogens like Cryptococcus gatti and Exserohilum rostratum.

Main Methods:

  • Review of current literature on fungal CNS infections.
  • Analysis of diagnostic approaches including imaging, antigen/antibody tests, and PCR.
  • Case study summary of emerging fungal pathogens.

Main Results:

  • Diagnosis can be challenging, often requiring invasive procedures for tissue retrieval.
  • Antigen, antibody, and PCR tests are available for cerebrospinal fluid (CSF) analysis, though PCR validation is pending.
  • Emergence of Cryptococcus gatti and an Exserohilum rostratum outbreak are noted.

Conclusions:

  • Optimal diagnostic strategies are crucial for managing fungal CNS infections.
  • Understanding host factors and clinical syndromes aids in differential diagnosis.
  • Awareness of emerging pathogens is essential for timely and effective treatment.

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