Central nervous system (CNS) fungal infections are challenging and difficult to diagnose and treat. This article introduces the high risk factors, pathogen spectrum and laboratory indicators that cause CNS fungal infection. As patients with CNS fungal infections are often accompanied by immunodeficiency, it is especially necessary for clinical early detection, early prevention, and early diagnosis, and timely and effective implementation of optimized diagnosis and treatment programs to prevent further deterioration of the disease.
Central Nervous System ; Central Nervous System Fungal Infections/microbiology* ; Central Nervous System Infections ; Fungi ; Humans ; Risk Factors

Central Nervous System Fungal Infections ; complications ; Diabetic Ketoacidosis ; complications ; Humans ; Male ; Middle Aged ; Mucormycosis ; complications ; Nose Diseases ; complications

OBJECTIVETo study the clinical value of cranial magnetic resonance imaging (MRI) in the diagnosis and treatment of central nervous system candidiasis (CNSC), which has no specific clinical manifestations and has no rapid and specific diagnostic tools.

METHODSA retrospective analysis was performed on the clinical data of 10 children who were diagnosed with CNSC in Beijing Children's Hospital Affiliated to Capital Medical University between 2009 and 2013.

RESULTSNine of the 10 children underwent cranial MRI within 8 days after admission, and 5 of the 9 children underwent contrast-enhanced MRI at the same time. Eight of the 9 children showed the features of meningoencephalitis, and 6 cases were accompanied by varying degrees of brain atrophy; one case showed hydrocephalus and cerebral abscess, and another case showed leukoencephalopathy. Six cases were found to have the features of cerebral vasculitis after infection in the first MRI after admission, including cerebral infarction (2 cases), venous sinus thrombosis (3 cases), and Moyamoya disease (1 case). Infectious granulomatous lesions were confirmed by contrast-enhanced MRI in 3 cases. Given the clinical manifestations, 8 of the 9 cases were diagnosed as suspected CNSC after MRI, and 7 of these cases received antifungal therapy before the pathogen test results were returned. The lesions on MRI were improved in 6 cases after 3-4 weeks of antifungal treatment. All the 10 children were diagnosed with CNSC by positive cerebrospinal fluid culture results.

CONCLUSIONSCranial MRI, especially contrast-enhanced MRI, is of great significance for the diagnosis and treatment of CNSC. To confirm the guidance of MRI in the diagnosis and treatment of CNSC, further case-control studies are needed.

Candidiasis ; diagnosis ; pathology ; Central Nervous System Fungal Infections ; diagnosis ; pathology ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Magnetic Resonance Imaging ; methods ; Male ; Retrospective Studies

OBJECTIVE: To study the clinical characteristics of invasive fungal infection secondary to systemic lupus erythematosus (SLE). METHODS: We observed the clinical features and experimental examination in 91 patients treated in Xiangya Hospital in recent years, of which 48 patients with invasive fungal infection and 41 patients without invasive fungal infection. RESULTS: The invasive fungal infection secondary to SLE mainly occurred in the lungs, nervous system, and urinary system. The fungi were mainly Candida albins and Aspergillus. The rate of invasive fungal infection in SLE patients and the level of CRP and TNF-α in these patients were significantly increased. The occurrence of invasive fungal infection was positively correlated with the prolonged course of disease, long-term use of immunosuppressants and antibiotics, and occurrence of complications, such as hypoproteinemia, leukocytopenia, and so on. The levels of C-reactive protein (CRP) and tumor necrosis factor-α(TNF-α) were increased in SLE patients with invasive fungal infection. CONCLUSION The clinical features of SLE patients with invasive fungal infections are long course of disease, long-time use of immunosuppressants or antibiotics, and occurrence of complications, such as hypoproteinemia or leukopenia. The level of CRP and TNF-α can be used as an important reference index for diagnosing invasive fungal infections.
Adolescent ; Adult ; Aspergillus ; isolation & purification ; C-Reactive Protein ; metabolism ; Candida albicans ; isolation & purification ; Central Nervous System Fungal Infections ; epidemiology ; Child ; China ; Female ; Humans ; Lung Diseases, Fungal ; epidemiology ; Lupus Erythematosus, Systemic ; microbiology ; Male ; Middle Aged ; Mycoses ; complications ; Tumor Necrosis Factor-alpha ; blood ; Young Adult

Invasive aspergillosis usually does not occur in immunocompetent patients. Recently, however, the incidence of invasive aspergillosis has been increasing in immunologically competent patients. It is difficult to diagnose neuroaspergillosis because of its varied radiological findings and clinical manifestations. We report a case of aspergillosis of the central nervous system, presenting as a mass-like lesion, in an immunocompetent patient. The patient was diagnosed after a surgical biopsy and treated with antifungal agents. The clinical outcome was good.
Antifungal Agents ; Aspergillosis ; Biopsy ; Central Nervous System ; Humans ; Immunocompetence ; Incidence ; Neuroaspergillosis ; Pyrimidines ; Triazoles

Aspergillosis of the central nervous system from sinonasal origin is rare in immunocompetent hosts. Due to the rarity of the cases in immunocompetent hosts, only few cases are reported in the previous literature. But, some cases reported diversity of clinical presentations in immunocompetent hosts. Aspergillosis of the central nervous system from sinonasal origin, bony invasion with only orbit or cranial base was more common than intracerebral aspergillosis in immunocompetent hosts. In this type of disease, although maxillary sinus is more commonly involved, sphenoid sinus and clivus are unusual sites for aspergillosis of central nervous system. Because of the anatomical position of sphenoid sinus, it is associated with poor prognosis with intracranial extension. We reported a case of the aspergillosis of central nervous system involving clivus in the immunocompetent host who was misdiagnosed as metastatic tumor or plasmacytoma due to the unusual location and host factor.
Aspergillosis* ; Brain Neoplasms ; Central Nervous System* ; Cranial Fossa, Posterior ; Immunocompetence ; Maxillary Sinus ; Neuroaspergillosis ; Orbit ; Plasmacytoma ; Prognosis ; Skull Base ; Sphenoid Sinus

Cerebral aspergillosis is rare and usually misdiagnosed because its presentation is similar to that of a tumor. The correct diagnosis is usually made intra-operatively. Cerebral abscess with fungal infection is extremely rare and few cases have been reported, but it carries a poor prognosis. A 73 year-old man presented with decreased visual acuity and paresis of the right cranial nerve III. Magnetic resonance imaging (MRI) revealed a mass in the right cavernous sinus, extened to the anterior crainial fossa and the superior orbital fissure. During surgery, a well encapsulated pus pocket was found, and histopathological examination of the mass resulted in the diagnosis of aspergillosis. Despite appropriate anti-fungal treatment, the patient eventually died from fatal cerebral ischemic change and severe brain swelling. The correct diagnosis of cerebral aspergillosis can only be achieved by histopathological examination because clinical and radiological findings including MRI are not specific. Surgical intervention and antifungal therapy should be considered the optimal treatment. Early diagnosis and aggressive antifungal treatment provide good results.
Aspergillosis ; Brain ; Brain Abscess ; Cavernous Sinus ; Early Diagnosis ; Humans ; Magnetic Resonance Imaging ; Neuroaspergillosis ; Oculomotor Nerve ; Orbit ; Paresis ; Pyrimidines ; Suppuration ; Triazoles ; Visual Acuity

No abstract available.
Meningitis, Cryptococcal*

During the last five decades, long-term therapy with immunosuppressive agents such as pulse cyclophosphamide in conjunction with high-dose corticosteroids has enhanced both patient survival and renal survival in patients with diffuse proliferative lupus nephritis. Nevertheless, severe side effects such as infectious complications remain the main cause of morbidity and mortality. Central nervous system aspergillosis is uncommon but life-threatening in lupus patients. In this single-patient case study, carotid aneurysm with sphenoidal sinusitis was suspected when severe epistaxis occurred during cyclophosphamide pulse therapy. With anti-fungal therapy, a graft stent was successfully deployed to the aneurysm and specimens of sphenoidal mucosa showed typical hyphae, indicating aspergillosis. Three months after stopping voriconazole treatment, two cerebral aneurysms that were revealed on MR images were successfully removed by aneurysmal clipping. The patient remained alive at one-year follow-up with lupus nephritis in remission. The rarity and high mortality of aspergillus-related fungal aneurysms have led to most cases being recognized postmortem. However, such aneurysms must be diagnosed early to prevent fatal complications by performing appropriate management such as surgical procedure or endovascular intervention.
Antifungal Agents/therapeutic use ; Female ; Humans ; Immunosuppressive Agents/adverse effects ; Intracranial Aneurysm/drug therapy/*etiology/surgery ; Lupus Nephritis/*complications/drug therapy ; Middle Aged ; Neuroaspergillosis/drug therapy/*etiology/surgery ; Pyrimidines/therapeutic use ; Stents ; Surgical Instruments ; Triazoles/therapeutic use

Antifungal Agents ; therapeutic use ; Aspergillus fumigatus ; pathogenicity ; Brain Abscess ; diagnostic imaging ; drug therapy ; microbiology ; Humans ; Infant ; Male ; Neuroaspergillosis ; complications ; pathology ; Occipital Lobe ; pathology ; Pulmonary Aspergillosis ; diagnostic imaging ; drug therapy ; microbiology ; Tomography, X-Ray Computed ; Treatment Outcome