title: Central nervous system fungal infections: observations from a large tertiary hospital in northern India.
abstract: OBJECTIVE
  To report our observations regarding fungal infections of the brain over two years from a large tertiary hospital in northern India. To identify fungal infections in immunocompetent and immunocompromised patients and to compare the two groups with respect to their age of occurrence, demographic data, clinical profile, radiological findings, response to treatment and outcome.
  
  
  METHODS
  All consecutive cases of central nervous system (CNS) fungal infections admitted to the hospital over two years were included in this study. The patients were categorized as immunocompetent and immunocompromised, the predisposing factors, symptoms and clinical presentation were studied in detail and the outcomes of the two groups were compared.
  
  
  RESULTS
  Of the 50 cases, 25(50%) were that of mucormycosis, 17(34%) were cryptococcosis and 8(16%) cases were that of aspergillosis. 14(28%) cases were immunocompetent and 36(72%) were immunocompromised. The outcome studied was as follows: 28% died of which 4% were HIV positive, 12% were diabetics with severe rhinorbital involvement, 2% had idiopathic thrombocytopenic purpura (ITP), 6% had advanced cancer and 4% had no predisposing illness.
  
  
  CONCLUSIONS
  We observed fungal infections of the brain in both immunocompetent and immunocompromised patients. In immunocompetent patients, early diagnosis and appropriate treatment frequently leads to recovery from the illness. The mortality and morbidity of fungal infections are less in the immunocompetent group of patients.
authors.affiliation: Department of Neurology, Sir Gangaram Hospital, New Delhi, India. sethinitinmd@hotmail.com
authors.forename: Prahlad K
authors.initials: PK
authors.lastname: Sethi
authors.forename: Laxmi
authors.initials: L
authors.lastname: Khanna
authors.forename: Anuradha
authors.initials: A
authors.lastname: Batra
authors.forename: Ish
authors.initials: I
authors.lastname: Anand
authors.forename: Nitin K
authors.initials: NK
authors.lastname: Sethi
authors.forename: Josh
authors.initials: J
authors.lastname: Torgovnick
authors.forename: Edward
authors.initials: E
authors.lastname: Arsura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications / Q000453:epidemiology; D001921:Brain / Q000382:microbiology / Q000473:pathology; D015984:Causality; D020314:Central Nervous System Fungal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D003453:Cryptococcosis / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D007121:Immunocompetence; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007194:India / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents