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Involuntary Movement Disorders in Central Nervous System Fungal Infections: A Systematic Review
Ravindra Kumar Garg1, Shweta Pandey2, Sanjay Singhal3
1Department of Neurology, Era's Lucknow Medical College & Hospital, Era University, Lucknow, India.
Background:
Central nervous system fungal infections, though rare, may lead to various movement disorders either due to direct fungal invasion or as adverse effects of antifungal drugs.
Objectives:
This systematic review aimed to consolidate all published cases and characterize the clinical patterns, mechanisms, and outcomes.
Methods:
A systematic review was conducted in line with PRISMA 2020 guidelines and registered with PROSPERO (CRD420251088348). Published case reports, series, and cohorts describing movement disorders in CNS fungal infections were identified from PubMed, EMBASE, Scopus, and Google Scholar.
Results:
Forty-five studies with 50 cases were included. Movement disorders directly attributed to fungal infection (n = 22; 44%) occurred predominantly in males (86.4%) with a mean age of 48 years. The most common pathogens were Cryptococcus neoformans (68.2%) and Coccidioides (13.6%). Chorea (45.5%), parkinsonism (27.3%), and tremor (13.6%) were frequent. Basal ganglia involvement was seen in 77.3% of patients. Antifungal drugs used included amphotericin B (77.3%), fluconazole (50%), and flucytosine (54.5%). Outcomes included full recovery (18.2%), partial improvement (36.4%), persistent symptoms (22.7%), and death (22.7%). Drug-induced movement disorders (n = 11; 22%) were linked mainly to amphotericin B (81.8%), with tremor (45.5%), myoclonus (18.2%), and dystonia (18.2%). Mortality was 45.5%. Ataxia with cerebellar involvement (n = 17; 34%) presented as gait (58.8%), truncal (29.4%), or limb ataxia (17.6%), with cerebellar abscesses (52.9%) and leptomeningeal enhancement (23.5%) on imaging. Recovery occurred in 64.7%, while 17.6% died.
Conclusion:
CNS fungal infections can lead to diverse variety of movement disorders. Early recognition of clinical patterns and neurotoxic drug effects is essential for optimal management.
Insights
Central nervous system fungal infections can cause movement disorders. Early recognition of clinical patterns and drug effects is crucial for managing these rare but serious conditions.
Area of Science:
- Neurology
- Infectious Diseases
- Pharmacology
Background:
- Central nervous system (CNS) fungal infections are rare but can manifest with various movement disorders.
- These disorders may arise from direct fungal invasion or as adverse effects of antifungal therapies.
Conclusions:
- CNS fungal infections present a diverse spectrum of movement disorders.
- Timely identification of specific clinical presentations and potential neurotoxic effects of antifungal medications is vital for effective patient management.
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