Abstract
Fungal central nervous system infections present in a myriad of clinical manifestation
and remain a significant diagnostic challenge. Presenting symptoms, cerebrospinal
fluid analysis, conventional fungal serum markers and imaging correlates of disease
are seldom sensitive or specific; fungal culture growth or histopathologic analysis
are often required for definitive diagnoses but limited by feasibility. Novel diagnostic
tools (such as the cryptococcal antigen and next-generation sequencing) have increased
diagnostic potency when available but require further studies to define their utility.
Invasive fungal infections are an emerging health threat in the setting of increased
immunomodulatory treatments, advancements in transplant medicine and increased world-wide
travel. Therefore, strong clinical suspicion from epidemiologic clues, clinical progression
and presence of CNS dissemination risk factors must be exercised to pursue broad diagnostic
workups and rapidly initiate medical and surgical management. This article will describe
the epidemiology, clinical presentations, diagnostic approach and therapeutic interventions
for fungal infections in the central nervous system.
Keywords
fungal CNS infection - chronic meningitis - brain abscess - histoplasmosis - coccidiomycosis
- blastomycosis - cryptococcal meningitis - candida meningitis - invasive fungal rhinosinusitis
- aspergillosis - fungal meningitis outbreak
