Fungal Infections of the Central Nervous System: Clinical, Radiographic and Laboratory Manifestations

Objective: To assess the epidemiological aspects of central nervous system (CNS) fungal infections at 2 tertiary care teaching hospitals. Patients and methods:We conducted a retrospective electronic medical record review of clinical, radiographic, laboratory, and microbiological data from patients at Mayo Clinic (Rochester, MN and Jacksonville, FL) with a proven or probable diagnosis of a CNS fungal infection from January 1, 2000 to December 31, 2014.Results: We identified 97 (91 proven, 6 probable) CNS fungal infections; 73 had fungal meningitis, 18 had a tissue diagnosis, and 6 had CNS imaging indicative of infection with positive fungal cultures from other organs.Most patients (67%) were male with a median age of 60 years; 64% were immunosuppressed, 29%of whom received prednisone ≥20 mg daily for ≥2 weeks.Cryptococcus spp was the most frequent infection identified (57%) and headache (47%) was the most common presenting symptom.Survival was significantly worse for patients with CNS aspergillosis compared to those with CNS Cryptococcus spp (hazard ratio, 10.92; P<0.001).Conclusion: CNS fungal infections have increased in frequency, particularly in patients requiring immunosuppression; most infections are caused by Cryptococcus spp.Aspergillus spp.CNS infections had 100% mortality.High-dose prednisone was the most common cause of immunosuppression, and headache was the most frequent symptom at presentation.