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Published on: March 22, 2012
Molecular diagnosis of invasive mycoses of the central nervous system
Matthew William McCarthy1, Thomas J Walsh2
1a Hospital Medicine , Joan and Sanford I Weill Medical College of Cornell University , New York , NY , USA.
Introduction:
In September 2012, the Centers for Disease Control and Prevention (CDC) began investigating an outbreak of fungal meningitis among patients who had received contaminated preservative-free methyl prednisolone acetate injections from the New England Compounding Center in Framingham, Massachusetts. Thousands of patients were potentially exposed to tainted corticosteroids, but establishing the diagnosis of fungal meningitis during the nationwide outbreak was difficult because little was known about the natural history of the disease. Areas covered: The challenges associated with this outbreak highlighted the need for rapid and reliable methodologies to assist in the diagnosis of invasive mycoses of the central nervous system (IMCNS), which may be devastating and difficult to treat. In this paper, we review the causative agents of these potentially-lethal infections, which include cryptococcal meningitis, cerebral aspergillosis, and hematogenous Candida meningoencephalitis. Expert commentary: While microscopy, culture, and histopathologic identification of fungal pathogens remain the gold standard for diagnosis, new platforms and species-specific assays have recently emerged, including lateral flow immunoassays (LFA), matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and multiplex PCR in conjunction with magnetic resonance (MR) to potentially aid in the diagnosis of IMCNS.
Insights
The 2012 fungal meningitis outbreak revealed diagnostic challenges for invasive mycoses of the central nervous system (IMCNS). New diagnostic methods are emerging to improve the detection of these serious fungal infections.
Area of Science:
- Infectious Diseases
- Mycology
- Neurology
Background:
- The 2012 fungal meningitis outbreak, linked to contaminated methylprednisolone acetate injections, exposed thousands to potentially lethal fungal infections.
- Diagnosing invasive mycoses of the central nervous system (IMCNS) during the outbreak was challenging due to limited knowledge of the disease's natural history.
Purpose of the Study:
- To review causative agents of IMCNS, including cryptococcal meningitis, cerebral aspergillosis, and Candida meningoencephalitis.
- To highlight the need for rapid and reliable diagnostic methodologies for IMCNS.
Main Methods:
- Review of literature on causative agents of IMCNS.
- Discussion of traditional diagnostic methods (microscopy, culture, histopathology).
- Exploration of emerging diagnostic platforms: lateral flow immunoassays (LFA), MALDI-TOF MS, and multiplex PCR.
Main Results:
- Causative agents of IMCNS include Cryptococcus, Aspergillus, and Candida species.
- Traditional diagnostic methods, while gold standards, can be slow.
- Emerging technologies offer potential for faster and more specific diagnosis of IMCNS.
Conclusions:
- The 2012 outbreak underscored critical gaps in diagnosing IMCNS.
- Advancements in diagnostic technologies like LFA, MALDI-TOF MS, and multiplex PCR show promise for improving patient outcomes.
- Continued development and validation of these new methods are crucial for effective management of invasive fungal infections of the CNS.
