Fungal Infections of the Central Nervous System

Abstract

Fungal infections of the central nervous system (CNS) represent a diagnostic and therapeutic challenge and are associated with high morbidity and mortality. The incidence of invasive fungal infections has increased over time with the rise of at-risk populations including organ transplants, chemotherapy, and human immunodeficiency virus infections among other conditions. Respiratory tract or sinuses are usually the most common port of entry, and then fungi spread hematogenously or by contiguity to the CNS. Infection may also occur after neurosurgical procedures and catheters, trauma, skin burns and penetrating wounds, and near drowning. CNS fungal infections may present as an acute or chronic meningitis, brain abscess, occupying space lesions, hydrocephalus, stroke, vasculitis, and arachnoiditis. In this chapter, the most common etiologies of CNS infections will be reviewed, including Cryptococcus, Candida, Aspergillus, Mucor, endemic dimorphic fungi (Histoplasma, Coccidioides, Blastomyces), and other more rare pathogens including Exserohilum rostratum and Scedosporium spp. Management include the use of amphotericin B, flucytosine, triazoles (voriconazole, posaconazole, fluconazole, itraconazole), and surgery for large brain mass. Long-term azole therapy may be needed for chronic infections to avoid recurrence.