1. Fungal Meningoencephalitis
Morning Report July 13, 2017

2. Fungal Meningoencephalitis
Fulminant among the immunocompromised
Indolent and insidious among the relatively immunocompetent
Broad symptom presentation, but most commonly reported included mental status changes (confusion, dementia), seizures, basilar meningeal signs/cranioneuropathies. Absense or presence of fever
Gram stains and cultures are frequently negative
Although rare: reported stroke syndromes from fungal infection–related vasculitis and thrombosis from angioinvasive molds, including Aspergillus and Mucor, more commonly than yeasts like Candida and Cryptococcus

3. Common Species Cryptoccocus Aspergillus Candida Mucormycosis
Exserohilum rostratum
Endemic Fungi: Histoplasma, Coccidiomycosis, Blastomycosis

4. Mucormycosis Genera: Rhizopus, Mucor,
Route of infection: inhalation of fungal sporangiospores have been released in the air or direct inoculation of organisms into disrupted skin or mucosa
Location: predisposition to invade nasal mucosa
Risk factor: Diabetes, immunocompromised states, iron overload states
diabetes mellitus as a predisposing factor for mucormycosis in 36%–88% of cases
Biopsy: non-septal hyphae on GMS silver stain
Lack of septal results in leakage of cellular material and rapid death follow biopsy - poor growth in culture
6 major clinical forms: (1) rhinocerebral, (2) pulmonary, (3) cutaneous, (4) gastrointestinal, (5) disseminated, and (6) uncommon rare forms, such as endocarditis, osteomyelitis, peritonitis, and renal infection
Black necrotis eschar – present <50%
Courtesy of Copyright ©2007 and UptoDate Mucormycosis (zygomycosis).
sinuses (39%), lungs (24%), and skin (19%)
rhinoorbital disease, with or without cerebral invasion, accompanied by bony destruction
CUTANEOUS: black necrotic eschar is the hallmark of mucormycosis
Experimental studies suggest that iron increases the susceptibility of the host to mucormycosis.

5. Mucormycosis – Rhinocerebral
Characteristics: vasotropic
Invade the endothelium causing thrombotic arteritis, infarct, hemorrhage and tissue necrosis
Involvement of the internal carotid artery, cavernous sinus, and ophthalmic artery is common.
Treatment: antifungals (amphotericin B) + surgical debridement
Mortality average 60% with poorer prognosis leading to fatality with delayed diagnosis and brain, cavernous sinus, or carotid involvement
They then germinate, forming angioinvasive hyphae that cause infarction of the involved tissue, giving in a “dry” gangrene appearance
fungus proliferates within the internal elastic lamina, dissecting it away from the media
The predisposition of patients with diabetes to acquire the disease may be partially related to
hyperglycemia, and the presence of ketoacidosis is presumed to induce a neutrophil defect, resulting in reduced
phagocytosis and chemotaxis.
amphotericin B and either posaconazole or

6. References
Petrikkos G, Skiada A, Lortholary O, et al. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis 2012
Weprin. Long-term survival in rhinocerebral mucormycosis. Case report. J Neurosurg Mar;88(3):570-5.
Panackal, A. Fungal Infections of the Central Nervous System. g Learning in Neurology: December Volume 21 - Issue 6, Neuroinfectious Disease - p 1662–1678
Chayakulkeeree, M M. Zygomycosis: the re-emerging fungal infection. European journal of clinical microbiology & infectious diseases. 2006