Fungal central nervous system infection caused by non- Candida yeasts and dimorphic fungi following neurosurgical procedures: Iatrogenic or not?

Most iatrogenic central nervous system fungal infections (ICNSFIs) are caused by Candida species or molds. However, the ICNSFIs caused by non-Candida yeasts and dimorphic molds have not been evaluated. In the literature review, we identified 24 cases of potential non-Candida yeasts and dimorphic molds-related ICNSFIs, 75% were associated with CNS diversion devices, and 63% were Cryptococcus neoformans infection. The median time from the procedure to the onset of CNS symptoms was 6.5 months. These patients had mild cerebrospinal fluid pleocytosis (median WBC, 12 × 10⁶/L). The 90-day mortality rate was 17%.