Fungal infections of the central nervous system in HIV-negative patients: Experience from a tertiary referral center of South India

Abstract

Objective:To describe the clinical, radiological, and cerebrovascular fluid (CSF) findings and the outcome of microbiologically or histopathologically proven fungal infections of the central nervous system (CNS) in HIV-negative patients.Methodology and Results:We identified definite cases of CNS mycosis by screening the medical records of our institute for the period 2000–2008. The clinical and imaging details and the outcome were abstracted from the medical records and entered in a structured proforma. There were 12 patients with CNS mycosis (i.e., 2.7% of all CNS infections treated in this hospital); six (50%) had cryptococcal infection, three (25%) had mucormycosis, and two had unclassified fungal infection. Four (33%) of them had diabetes as a predisposing factor. The common presentations were meningoencephalitis (58%) and polycranial neuritis (41%). Magnetic resonance imaging revealed hydrocephalus in 41% and meningeal enhancement in 25%, as well as some unusual findings such as subdural hematoma in the bulbocervical region, carpeting lesion of the base of the skull, and enhancing lesion in the cerebellopontine angle. The CSF showed pleocytosis (66%), hypoglycorrhachia (83%), and elevated protein levels (100%). The diagnosis was confirmed by meningocortical biopsy (in three cases), paranasal sinus biopsy (in four cases), CSF culture (in three cases), India ink preparation (in four cases), or by cryptococcal polysaccharide antigen test (in three cases). Out of the ten patients for whom follow-up details were available, six patients recovered with antifungal medications (amphotericin B, 1 mg/kg/day for the minimum period of 6 weeks) and/or surgical treatment. Four patients expired (only one of them had received antifungal therapy).Conclusions:Most patients with CNS mycosis recover with appropriate therapy, but the diagnosis and management of these rare infections remains a challenge to clinicians.

Mucormycosis in COVID-19 patients: predisposing factors, prevention and management

“…The global prevalence of mucormycosis ranges from 0.005 to 1.7 per million population, while its prevalence in India is nearly 80 times higher (0.14 per 1000) compared to developed countries, making India the country with the highest burden of mucormycosis [13][14][15]. It constituted 2.7% of all the fungal infections affecting central nervous system (CNS), treated at a tertiary care center in South India [16]. There are increasing reports of rhino-orbital mucormycosis in people with COVID-19, especially in India, in addition to several anecdotal reports in the print and electronic media [17].…”

Genomic Analyses of Cladophialophora bantiana, a Major Cause of Cerebral Phaeohyphomycosis Provides Insight into Its Lifestyle, Virulence and Adaption in Host

“…CNS fungal infections are uncommon as the occurrence is very less and usually associated with devastating consequences in immunocompetent individuals [ 3 ]. CNS infections which are caused by fungi can cause one or more the symptoms such as acute or chronic meningitis, encephalitis, abscesses, or myelopathy [ 4 , 5 ]. Cryptococcus neoformans is the predominant causes of cryptococcosis in immunocompetent individuals, while Zygomycetes, Aspergillus , and Candida species are the most common causes of such infection in immunocompromised patients [ 6 , 7 ].…”