CNS fungal infections: A review

Nathan, Cody; Emmert, Brian E; Nelson, Ernest; Berger, Joseph R.

doi:10.1016/j.jns.2021.117325

Cited by 18 publications

(26 citation statements)

References 65 publications

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“…Particularly for GM, several case reports and small case series about the utility of CSF GM testing had been published 18 . A very recent review of the literature indicates a sensitivity of 80% 3 . Notably, the 2017 ESCMID‐ECM‐ERS guideline includes a grade B recommendation for GM testing from CSF but at the same time warns of low evidence and a lacking cut‐off 15 .…”

Section: Discussionmentioning

confidence: 99%

“…5 Since there is still a lack of solid data on the use of molecular methods for the detection of CNS candidiasis, cultural detection from CNS samples remains the gold standard to date. 3,5 Invasive aspergillosis (IA) is the most common mould infection, which is a particular threat for immunocompromised patients. 1,2 Typically, the disease manifests in the lungs, which are the primary entry point for the ubiquitous, airborne Aspergillus spores.…”

Section: Introductionmentioning

confidence: 99%

“…Mortality rates, which are reported to range from 10% to 70% in IC, increase to 90% upon CNS involvement 5 . The two major risk factors for CNS candidiasis are intracranial procedures, for example neurosurgery or implantation of ventricular drains and candidemia 3,5 . The rate of haematogenous dissemination into the brain during candidemia is estimated to be as high as 6% in adults and >60% in neonates 5 .…”

Section: Introductionmentioning

confidence: 99%

“…Hundreds of thousands of fatal outcomes per year are attributable to the basidiomycete yeast Cryptococcus , which is the most common cause of fungal meningoencephalitis 1,2 . However, other fungal pathogens, including Aspergillus and Candida species, can also cause central nervous system (CNS) infections, which are associated with devastating outcomes 3 …”

Section: Introductionmentioning

confidence: 99%

“…Following Cryptococcus spp. and Coccidioides immitis , Candida is the third most common causative agent of fungal meningoencephalitis accounting for 8% of cases 3 . However, the disease often remains undetected, and autopsy studies suggest that CNS candidiasis is an underdiagnosed disease 3,5 .…”

Section: Introductionmentioning

confidence: 99%

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Serologic biomarkers in Candida and Aspergillus infections of the central nervous system: A comparison of galactomannan, mannan and β‐1,3‐D‐gucan testing from serum and cerebrospinal fluid

Förster

Hoenigl

Suerbaum

et al. 2022

Mycoses

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Background The incidence of Aspergillus and Candida CNS infection, which are characterised by high mortality rates, is underestimated. This underdiagnosis presumably results from the limitations of available diagnostic tools and the need for invasive sampling. Little is known about the role of serologic biomarkers in the setting of CNS aspergillosis and candidiasis. Patients, materials and methods: Serum and cerebrospinal fluid (CSF; 10) samples of 19 patients, whose CNS specimens yielded growth of Aspergillus or Candida, were analysed for different biomarkers for fungal infection, that is galactomannan (GM), galactomannoprotein (GP), mannan, anti‐mannan‐antibodies and β‐1,3‐D‐glucan (BDG). Serum and CSF specimens of time‐matched patients (two each for every case of fungal CNS infection) were included as controls. Results Galactomannan, GP and BDG seropositivity was found in one, two and three of five cases of CNS aspergillosis. BDG and mannan/anti‐mannan‐antibody sensitivity in proven CNS candidiasis was 40% and 20%, respectively. Applying the serum cut‐off, sensitivity in CSF testing was 100% for GM and BDG and 50% for mannans. While serum specificity for all assays ranged from 89 to 97%, specificity for CSF BDG was only 70%. No false‐positive GM results from CSF were obtained. Conclusion Sensitivity for diagnosing CNS aspergillosis and CNS candidiasis from serum is mediocre for all serological biomarkers. GM testing in CSF proved excellent performance. With a sensitivity of 100% but a specificity of only 70%, CSF BDG might be most useful when used in patients with a high pre‐test probability.

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Section: Discussionmentioning

confidence: 99%