title: Fungal central nervous system infections: prevalence and diagnosis.
abstract: Fungal infections of the central nervous system (CNS) are rare but they pose a significant challenge. Their prevalence spans a wide array of hosts including immunosuppressed and immunocompetent individuals, patients undergoing neurosurgical procedures and those carrying implantable CNS devices. Cryptococcus neoformans and Aspergillus spp. remain the most common pathogens. Magnetic resonance imaging can help localize the lesions, but diagnosis is challenging since invasive procedures may be needed for the retrieval of tissue, especially in cases of fungal abscesses. Antigen and antibody tests are available and approved for use in the cerebrospinal fluid (CSF). PCR-based techniques are promising but they are not validated for use in the CSF. This review provides an overview on the differential diagnosis of the fungal CNS disease based on the host and the clinical syndrome and suggests the optimal use of diagnostic techniques. It also summarizes the emergence of Cryptococcus gatti and an unanticipated outbreak caused by Exserohilum rostratum.
authors.affiliation: Infectious Disease Division, Alpert Medical School and Brown University, Rhode Island Hospital, RI, USA.
authors.forename: Irene S
authors.initials: IS
authors.lastname: Kourbeti
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Mylonakis
mesh_terms: D000914:Antibodies, Viral / Q000134:cerebrospinal fluid*; D000956:Antigens, Viral / Q000134:cerebrospinal fluid*; D001230:Aspergillus / Q000276:immunology / Q000302:isolation & purification*; D002490:Central Nervous System / Q000382:microbiology / Q000473:pathology; D020314:Central Nervous System Fungal Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D056285:Cryptococcus gattii / Q000276:immunology / Q000302:isolation & purification*; D003455:Cryptococcus neoformans / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D008279:Magnetic Resonance Imaging; D015995:Prevalence
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral