CNS fungal infections

Fungal infections

Cryptococcal meningitis (AIDS)

Candida meningitis (neonates and neurosurgery)

Brain abscesses

Cryptococcoal meningitis

Caused by one of two species:

◦Cryptococcus neoformans

◦Cryptococcus gattii

Acquired by inhalation of the

basidiospore from the environment

Cryptococcoal meningitis

AIDS defining opportunistic infection

Other increased risk populations

include:

◦Lymphomas (e.g.Hodgkin's lymphoma)

◦Long-term corticosteroid therapy

Diagnosis

Symptoms: Fever, fatigue, headache, neck

stiffness, blurred vision and confusion

CSF examination and culture

◦ India ink capsule staining

◦ Detection of cryptococcal antigen (capsular material)

◦ Capsulated yeast in culture

Note: Candida species is not capsulated

Fungal Brain infections Apergillus species

Scedosporium apiospermum

Zygomycetes

Candida species

Pigmented fungi:

◦ Rhinocladiella mackenziei (Phaeohyphomycosis)

◦ Cladophialophora (Phaeohyphomycosis)

◦ Exophiala (Phaeohyphomycosis)

◦ Fonsecaea  (Phaeohyphomycosis)

A case of Scedosporium apiospermum brain infection

A 51-year-old farmer had a near-drowning

Developed bronchopneumonia and treated

with antibiotics

Two weeks later the patient developed

bifrontal headache, with features suggestive

of raised intracranial pressure. 

Gopinath M, Cherian A, Baheti NN, Das A, Antony M, Sarada C. An elusive diagnosis: Scedosporium apiospermum infection after near-drowning. Ann Indian Acad Neurol 2010;13:213-5

Laboratory diagnosis

Clinical material:

◦ Aspirated pus

◦ CSF

◦ Tissue biopsies

Direct Microscopy:

◦ 10% KOH, H&E, PAS and Silver stain

Culture:

◦ SDA and BHIA

Management

Surgical excision or drainage

Antifungal (Amphotericin B or

Azoles)