Neurology · MU Sofia

53. Fungal infections of the nervous system

Covers fungal infections of the nervous system as opportunistic infections in immunocompromised patients, with cryptococcal meningitis as the most common form. Explains the main pathogens, how infection spreads to the CNS, and the clinical forms: meningitis, meningoencephalitis, and brain abscess or granuloma. Also outlines the special forms (cryptococcal, cerebral aspergillosis, rhinocerebral mucormycosis), CSF and imaging findings, differential diagnosis, and treatment.

Inside: 1 section · 1 labelled picture · 16 flashcards · 2 min

Topic 53 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 288 words (2 min of reading), with 16 flashcards.

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  1. Fungal infeciotn of nervous system

Fungal infeciotn of nervous system

Definition: Fungal infections of the nervous system are opportunistic infections affecting the meninges, brain, spinal cord, or blood vessels, occurring mainly in immunocompromised patients (HIV/AIDS, transplant recipients, malignancy, diabetes, corticosteroid therapy).

Etiology (Important Fungi)

  • Most common pathogens: Cryptococcal Meningitis – most common CNS fungal infection. Candida. Aspergillus. Mucormycosis. Histoplasma, Coccidioides (endemic areas)

Pathogenesis

  • Usually acquired by inhalation
  • Hematogenous spread to CNS
  • Causes: Chronic meningitis. Meningoencephalitis. Brain abscesses. Cerebral vasculitis/infarction

Clinical Forms

A. Fungal Meningitis (most common)

  • Clinical Features: Chronic or subacute onset. Persistent headache. Fever. Neck stiffness. Nausea/vomiting. Altered consciousness (late)

B. Meningoencephalitis

  • Features: Confusion. Seizures. Focal neurological deficits. Behavioral changes

C. Brain Abscess / Granuloma

  • Features: Headache. Focal deficits. Seizures. Signs of increased intracranial pressure

Special Forms

  1. 1.Cryptococcal Meningitis: Most common in AIDS patients.
  • Features: Headache. Fever.Cranial nerve palsies. Raised intracranial pressure. Subacute course
  1. 2.Cerebral Aspergillosis
  • Features: Brain abscesses. Stroke-like deficits. Seizures
  1. 3.Rhinocerebral Mucormycosis
  • Seen in:Diabetes mellitus. Severe immunosuppression
  • Features: Facial pain. Orbital involvement. Cranial nerve palsies. Rapid progression

Examination Findings

  • Neurological Examination: Meningeal signs. Cranial nerve deficits. Focal motor deficits. Cognitive impairment
  • General Examination: Fever. Evidence of immunosuppression

CSF Findings

  • Typical fungal meningitis: ↑ Opening pressure (often markedly elevated). Lymphocytic pleocytosis. ↑ Protein. ↓ Glucose
  • Cryptococcus: Positive India ink stain (classic). Cryptococcal antigen positive

Neuroimaging

  • MRI/CT may show: Hydrocephalus. Meningeal enhancement. Brain abscesses. Granulomas (fungal masses)

Differential Diagnosis

  1. 1. Tuberculous meningitis: Similar chronic course. Similar CSF pattern
  2. 2. Viral meningitis: Normal glucose. Milder course
  3. 3. Bacterial meningitis: Acute onset. Neutrophilic CSF
  4. 4. Brain tumor: No infectious signs

Treatment

  • Cryptococcal meningitis: Amphotericin B + flucytosine. Followed by fluconazole
  • Other fungal infections: Amphotericin B. Voriconazole (aspergillosis). Surgical treatment if abscess present

Prognosis: Depends on immune status. High mortality if diagnosis is delayed

Better outcomes with early antifungal therapy.

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