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Fungal and Parasitic CNS Infections

Pratibha Singhi1,2, Arushi Gahlot Saini3

  • 1Department of Pediatric Neurology and Neurodevelopment, Medanta, The Medicity, Gurgaon, Haryana, India. doctorpratibhasinghi@gmail.com.

Indian Journal of Pediatrics
|November 12, 2017
PubMed

Insights

Central nervous system fungal infections in children range from those affecting healthy hosts to opportunistic infections in immunocompromised individuals. Early suspicion and diagnosis via cerebrospinal fluid analysis, PCR, and neuroimaging are crucial for effective antifungal therapy and management.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Mycology

Background:

  • Central nervous system (CNS) fungal infections are categorized by host immunity: primary pathogens in healthy individuals (e.g., Cryptococcus) and opportunistic pathogens in immunocompromised hosts (e.g., Candida, Aspergillus).
  • Clinical presentations in children include chronic meningitis/meningoencephalitis, brain abscesses, rhino-cerebral syndrome, and fungal ventriculitis.
  • Suspicion is warranted in children with subacute to chronic febrile encephalopathy or meningitis, especially with increased intracranial pressure, seizures, or nasal discharge.

Purpose of the Study:

  • To provide a comprehensive overview of central nervous system fungal infections in children.
  • To highlight diagnostic approaches and management strategies.
  • To briefly touch upon parasitic CNS infections in children.

Main Methods:

  • Review of clinical manifestations, diagnostic methods, and management principles for CNS fungal infections in pediatric populations.
  • Discussion of diagnostic tools including cerebrospinal fluid analysis, cultures, PCR, special stains, serological tests, and neuroimaging.
  • Brief mention of parasitic infections like cerebral malaria and amebic meningoencephalitis.

Main Results:

  • CNS fungal infections present with diverse syndromes like meningitis, abscesses, and rhino-cerebral disease.
  • Diagnosis relies on a combination of clinical suspicion, laboratory tests (CSF analysis, PCR, serology), and neuroimaging.
  • Management involves targeted antifungal therapy, supportive care, addressing predisposing factors, and potential surgical intervention.

Conclusions:

  • Prompt recognition and diagnosis of CNS fungal infections in children are vital for timely and effective treatment.
  • A multidisciplinary approach combining antifungal therapy, supportive care, and surgical consideration improves outcomes.
  • Parasitic infections also represent significant causes of CNS disease in pediatric patients.
Keywords:
Cerebral malariaChronic meningitisFree-living amebaeFungal infectionParasitic infection

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