Fungal Infections of the Brain

Abstract

CNS fungal infections are associated with high morbidity and mortality. The most frequent etiology is cryptococcosis, which causes subacute meningoencephalitis among patients with advanced HIV and solid organ transplant. Diagnosis is based on cerebrospinal fluid (CSF) antigen testing or culture. The treatment of choice is liposomal amphotericin B (LAmB) with 5-flucytosine for 2 weeks, followed by prolonged maintenance with fluconazole. Hematogenous dissemination of invasive candidiasis causes CNS micro abscesses and meningitis. CSF culture is insensitive, the determination of β-D glucan may aid diagnosis. Initial treatment with LAmB and prolonged maintenance with azoles is recommended. CNS involvement in the setting of disseminated histoplasmosis, blastomycosis and coccidioidomycosis occurs among immunocompromised patients living or visiting endemic zones. Diagnosis is difficult, cultures are insensitive, antigen testing or serology aids the diagnosis. CNS invasion in the setting of invasive aspergillosis and mucormycosis may be seen by local invasion or hematogenous dissemination. Early surgical consultation is a priority in addition to antifungal therapy. Dematiaceous fungi are emergent mycosis that may cause healthcare related outbreaks and CNS infection.