title: Central nervous system cladosporiosis: an account of ten culture-proven cases.
abstract: BACKGROUND
  Central nervous system (CNS) cladosporiosis is a rare infection caused by Cladophialophora bantiana. It has varied presentation and poor outcome. Most of the available data in the literature are reviews of individual case reports.
  
  
  OBJECTIVE
  To describe the clinical, radiological and mycological features of 10 cases of C. bantiana managed at a single tertiary center. To analyze the various treatment options, factors associated with outcome and to review the relevant literature.
  
  
  METHODS
  This is a retrospective study of 10 patients with CNS cladosporiosis managed at National Institute of Mental Health and Neurosciences from 1979 to 2006. It is a descriptive study. The case records were reviewed for clinical presentation, radiological features, management and outcome. Only those patients in whom the fungus could be isolated on culture were included in the study.
  
  
  RESULTS
  The age of the patients ranged from three to 42 years. Nine patients presented with features of space-occupying lesion and one patient with chronic meningitis. There were no specific clinical or radiological features. None of patients had impaired immune status. This infection presented as two pathomorphological forms - diffuse meningoencephalitis and focal abscesses. Burr hole tapping and excision are the surgical options. Both patients with burr hole tapping required excision of abscess subsequently. Two out of seven patients with abscess expired compared to all three patients with diffuse meningoencephalitis who expired. Recurrences occurred in four of the five patients following excision of the abscess. Combination antifungal treatment had better result than monotherapy. The outcome was poor with survival of only 50%.
  
  
  CONCLUSIONS
  Thorough microbiological examination is required to diagnose CNS infection caused by C. bantiana. The outcome is better in patients with abscess. Excision of the abscess followed by combination antifungal therapy results in better outcome. Close follow-up is required due to high risk of recurrence.
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore - 29, India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Garg
authors.forename: Indira B
authors.initials: IB
authors.lastname: Devi
authors.forename: Girish V
authors.initials: GV
authors.lastname: Vajramani
authors.forename: S
authors.initials: S
authors.lastname: Nagarathna
authors.forename: S
authors.initials: S
authors.lastname: Sampath
authors.forename: B A
authors.initials: BA
authors.lastname: Chandramouli
authors.forename: A
authors.initials: A
authors.lastname: Chandramuki
authors.forename: S K
authors.initials: SK
authors.lastname: Shankar
mesh_terms: D000293:Adolescent; D000328:Adult; D002490:Central Nervous System / Q000382:microbiology*; D002675:Child, Preschool; D002862:Chromoblastomycosis / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D002963:Cladosporium / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult