Forensic Neuropathologic Phenotypes of Fungal Central Nervous System Infections

Abstract

Fungal infections of the central nervous system (FI-CNS) are life-threatening infections that most commonly affect immunocompromised individuals, but immunocompetent individuals may also be infected. Although FI-CNS are relatively rare, the prevalence of FI-CNS is on the rise because of the increasing number of transplant recipients, human immunodeficiency virus-infected individuals, and use of immunosuppressive therapies. Most cases of FI-CNS originate from outside the central nervous system. The etiologic fungi can be classified into 3 fungal groups: molds, dimorphic fungi, and yeasts. The clinical presentation of FI-CNS is highly variable and may be difficult to diagnose premortem. We present a case series of 3 patients, each infected by 1 representative species from each of the 3 fungal groups (Aspergillus species, Blastomyces species, Candida species) to illustrate different neuropathologic phenotypes of FI-CNS. All 3 patients had no history of immunodeficiency and were not suspected to have FI-CNS until they were diagnosed at autopsy. Fungal infections of the central nervous system are often fatal due to delayed diagnosis and diagnostic testing. Awareness of such poly-phenotypic manifestations of FI-CNS will be helpful in reducing delayed diagnosis. It is important for clinicians to include FI-CNS on the differential diagnosis when radiographic findings are nonspecific.

Fungal infection of the central nervous system: Autopsy analysis of six cases

“…Moreover, cryptococcal infection has been described in the immunocompetent individual. In a recently published study by Wu et al, 15 fungal infection was not an antemortem diagnostic consideration which could have been attributed to the non-specific clinical features and low index of suspicion by the clinicians.…”

“…18 While cryptococcal infection is the most common cause of CNS fungal infection as evidenced in this study, the species identified by Wu and colleagues were Aspergillus, Blastomyces and Candida. 15 More cases of Aspergillus have been described recently; however, Blastomyces is very rare. This further highlights the importance of autopsy in identification of these fungal infections, including rare species.…”