CNS fungal infections

Fungal infections of the central nervous system (CNS) are uncommon.  However, they do occur often enough that the provider should know when to include them in the differential diagnosis and how to go about establishing the diagnosis.

Multi-state Outbreak of CNS Fungal Infections

Interest and attention in these infections spiked in 2012–2013 with the nationwide outbreak of fungal meningitis due to three lots of contaminated methylprednisolone [1]. The methylprednisolone was used in epidural spinal injection for relief of back pain. Approximately 753 patients were identified with CNS infections in this outbreak with 64 deaths [2]. The organism most commonly recovered was Exserohilum rostratum, a dematiaceous (pigmented) mold. CNS infections with this organism had not been previously reported.  Dematiaceous organisms are common causes of chronic fungal sinusitis, but the one dematiaceous organism that may rarely reach the CNS is Cladosporium bantiana [3].

The types of infections seen with the multistate outbreak included:

  •             Meningitis only (CNS)
  •             Meningitis plus paraspinal infection (CNS)
  •             Stroke only (CNS)
  •             Paraspinal infection only (CNS)
  •             Paraspinal plus peripheral joint infection (CNS)
  •             Peripheral joint infection only (non-CNS)

Among the 37 patients seen at our center, the most common presenting symptom was headache (100%), followed by word-finding difficulty (72%). Other symptoms occurring in > 50% of the patients included nausea/vomiting, fever, malaise and fatigue [4].

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