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)