PMID- 26633781
OWN - NLM
STAT- MEDLINE
DCOM- 20160915
LR  - 20151204
IS  - 1538-6899 (Electronic)
IS  - 1080-2371 (Linking)
VI  - 21
IP  - 6 Neuroinfectious Disease
DP  - 2015 Dec
TI  - Fungal Infections of the Central Nervous System.
PG  - 1662-78
LID - 10.1212/CON.0000000000000241 [doi]
AB  - PURPOSE OF REVIEW: This article summarizes current knowledge on the epidemiology, 
      clinical presentations, diagnosis, and management of selected fungal infections 
      of the central nervous system (CNS). Key syndromes, differential diagnoses, and 
      therapeutic interventions according to host immune status and exposure are 
      reviewed. RECENT FINDINGS: Advancements in imaging of the brain and spinal cord, 
      and molecular DNA and antigen-based laboratory diagnostics afford improved 
      sensitivity for CNS mycoses. Newer therapeutic strategies may improve outcomes if 
      provided early and host immunosuppression is abrogated. Adjunctive corticosteroid 
      use for disabling neuroinflammation and cerebral edema in the setting of 
      microbiological control may be considered. In addition, nonspecific presentations 
      and absence of fevers in patients without human immunodeficiency virus suggest 
      that screening for Cryptococcus meningitis be performed in all patients with 
      subcortical dementias using a simple CSF or serum antigen test. SUMMARY: CNS 
      fungal infections comprise a wide spectrum of clinical syndromes, including 
      abscesses, meningitis/meningoencephalitis, focal masses, stroke/vasculitides, 
      immune reconstitution inflammatory syndrome (IRIS), and spinal pathologies such 
      as arachnoiditis. The main etiologies include Aspergillus, Cryptococcus, Candida, 
      Mucorales, dematiaceous molds, and dimorphic endemic fungi, with the route of 
      acquisition being respiratory or traumatic inoculation with subsequent spread 
      hematogenously or contiguously. Proper management focuses on early effective 
      antifungal therapy and surgery for large or compressive mass lesions. While 
      adjunctive recombinant cytokine or growth factor use has been supported in 
      certain hosts with refractory infections, IRIS-like reactions may occur, 
      suggesting alternative approaches such as high-dose pulse corticosteroids 
      followed by taper.
FAU - Panackal, Anil A
AU  - Panackal AA
FAU - Williamson, Peter R
AU  - Williamson PR
LA  - eng
GR  - Intramural NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Intramural
PT  - Review
PL  - United States
TA  - Continuum (Minneap Minn)
JT  - Continuum (Minneapolis, Minn.)
JID - 9509333
SB  - IM
MH  - *Central Nervous System Fungal 
      Infections/diagnosis/epidemiology/physiopathology/therapy
MH  - Humans
EDAT- 2015/12/04 06:00
MHDA- 2016/09/16 06:00
CRDT- 2015/12/04 06:00
PHST- 2015/12/04 06:00 [entrez]
PHST- 2015/12/04 06:00 [pubmed]
PHST- 2016/09/16 06:00 [medline]
AID - 00132979-201512000-00013 [pii]
AID - 10.1212/CON.0000000000000241 [doi]
PST - ppublish
SO  - Continuum (Minneap Minn). 2015 Dec;21(6 Neuroinfectious Disease):1662-78. doi: 
      10.1212/CON.0000000000000241.