title: Molecular diagnosis of invasive mycoses of the central nervous system.
abstract: In September 2012, the Centers for Disease Control and Prevention (CDC) began investigating an outbreak of fungal meningitis among patients who had received contaminated preservative-free methyl prednisolone acetate injections from the New England Compounding Center in Framingham, Massachusetts. Thousands of patients were potentially exposed to tainted corticosteroids, but establishing the diagnosis of fungal meningitis during the nationwide outbreak was difficult because little was known about the natural history of the disease. Areas covered: The challenges associated with this outbreak highlighted the need for rapid and reliable methodologies to assist in the diagnosis of invasive mycoses of the central nervous system (IMCNS), which may be devastating and difficult to treat. In this paper, we review the causative agents of these potentially-lethal infections, which include cryptococcal meningitis, cerebral aspergillosis, and hematogenous Candida meningoencephalitis. Expert commentary: While microscopy, culture, and histopathologic identification of fungal pathogens remain the gold standard for diagnosis, new platforms and species-specific assays have recently emerged, including lateral flow immunoassays (LFA), matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and multiplex PCR in conjunction with magnetic resonance (MR) to potentially aid in the diagnosis of IMCNS.
authors.affiliation: a Hospital Medicine , Joan and Sanford I Weill Medical College of Cornell University , New York , NY , USA.
authors.forename: Matthew William
authors.initials: MW
authors.lastname: McCarthy
authors.affiliation: b Transplantation-Oncology Infectious Diseases Program , Weill Cornell Medical Center , New York , NY , USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
mesh_terms: D002177:Candidiasis / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D004196:Disease Outbreaks; D004340:Drug Contamination; D006801:Humans; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D008590:Meningoencephalitis / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D008775:Methylprednisolone / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077555:Methylprednisolone Acetate; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D020953:Neuroaspergillosis / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics
chemical_list: D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone
keywords: Exserohilum rostratum; MALDI-TOF; PCR; dematiaceous mold; invasive mycoses; magnetic resonance