Neuroinfections caused by fungi

Abstract

BackgroundFungal infections of the central nervous system (FIs-CNS) have become significantly more common over the past 2 decades. Invasion of the CNS largely depends on the immune status of the host and the virulence of the fungal strain. Infections with fungi cause a significant morbidity in immunocompromised hosts, and the involvement of the CNS may lead to fatal consequences.MethodsOne hundred and thirty-five articles on fungal neuroinfection in PubMed, Google Scholar, and Cochrane databases were selected for review using the following search words: “fungi and CNS mycoses”, CNS fungal infections”, “fungal brain infections”, " fungal cerebritis”, fungal meningitis”, “diagnostics of fungal infections”, and “treatment of CNS fungal infections”. All were published in English with the majority in the period 2000–2018. This review focuses on the current knowledge of the epidemiology, clinical presentations, diagnosis, and treatment of selected FIs-CNS.ResultsThe FIs-CNS can have various clinical presentations, mainly meningitis, encephalitis, hydrocephalus, cerebral abscesses, and stroke syndromes. The etiologic factors of neuroinfections are yeasts (Cryptococcus neoformans, Candida spp., Trichosporon spp.), moniliaceous moulds (Aspergillus spp., Fusarium spp.), Mucoromycetes (Mucor spp., Rhizopus spp.), dimorphic fungi (Blastomyces dermatitidis, Coccidioides spp., Histoplasma capsulatum), and dematiaceous fungi (Cladophialophora bantiana, Exophiala dermatitidis). Their common route of transmission is inhalation or inoculation from trauma or surgery, with subsequent hematogenous or contiguous spread. As the manifestations of FIs-CNS are often non-specific, their diagnosis is very difficult. A fast identification of the etiological factor of neuroinfection and the application of appropriate therapy are crucial in preventing an often fatal outcome. The choice of effective drug depends on its extent of CNS penetration and spectrum of activity. Pharmaceutical formulations of amphotericin B (AmB) (among others, deoxycholate-AmBd and liposomal L-AmB) have relatively limited distribution in the cerebrospinal fluid (CSF); however, their detectable therapeutic concentrations in the CNS makes them recommended drugs for the treatment of cryptococcal meningoencephalitis (AmBd with flucytosine) and CNS candidiasis (L-AmB) and mucormycosis (L-AmB). Voriconazole, a moderately lipophilic molecule with good CNS penetration, is recommended in the first-line therapy of CNS aspergillosis. Other triazoles, such as posaconazole and itraconazole, with negligible concentrations in the CSF are not considered effective drugs for therapy of CNS fungal neuroinfections. In contrast, clinical data have shown that a novel triazole, isavuconazole, achieved considerable efficacy for the treatment of some fungal neuroinfections. Echinocandins with relatively low or undetectable concentrations in the CSF do not play meaningful role in the treatment of FIs-CNS.ConclusionAlthough the number of fungal species causing CNS mycosis is increasing, only som...

Infectious Etiologies of Stroke

“…78 The pathogen most commonly enters the CNS by hematologic spread but can also arrive via direct extension from paranasal sinuses, orbits, and the inner ear or following trauma or neurosurgery. 76,79 The most significant risk factors for CNS involvement are neutropenia and corticosteroid use, with elevated risk seen in all immunocompromised states. 78,79 CNS involvement is associated with a very high mortality rate, recently estimated as 40 to 80% in immunocompetent individuals and 90 to 100% in the immunosuppressed.…”

“…76,79 The most significant risk factors for CNS involvement are neutropenia and corticosteroid use, with elevated risk seen in all immunocompromised states. 78,79 CNS involvement is associated with a very high mortality rate, recently estimated as 40 to 80% in immunocompetent individuals and 90 to 100% in the immunosuppressed. 79…”

“…78,79 CNS involvement is associated with a very high mortality rate, recently estimated as 40 to 80% in immunocompetent individuals and 90 to 100% in the immunosuppressed. 79…”

Fungi as causative agents of healthcare-associated infections

“…Cladophialophora bantiana). Postaci zakażeń mogą przybierać formę zapalenia mózgu i opon mózgowo-rdzeniowych, wodogłowia, ropni mózgu i udarów [49].…”

Complexo Candida parapsilosis: identificação molecular das espécies, análise proteômica dos biofilmes por MALDI-TOF MS e investigação de um surto envolvendo isolados clínicos resistentes aos azólicos

“…O acometimento do sistema nervoso central (SNC) por Candida spp. pode ser decorrente da disseminação da infecção, e eleva as taxas de mortalidade para aproximadamente 90% (Góralska et al, 2018). O maior número de casos de candidíase do SNC tem sido observado em crianças e neonatos (Katragkou et al, 2017).…”