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Spectrum of fungal infection in a neurology tertiary care center in India

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Abstract

There is a paucity of studies on spectrum of fungal infections in neurology care. This study reports clinical, MRI and outcome of patients with central nervous system (CNS) fungal infections. 39 patients with CNS fungal infections treated in neurology service during the last 3 years were included and a detailed medical history and clinical examination were undertaken. Cranial MRI including paranasal sinuses were carried out and the location and nature of abnormalities were noted. Fungal infection was confirmed by CSF examination or histopathology. Death during hospital stay was noted. The median age was 37 (8–72) years and 8 were females. The clinical features included altered sensorium in 31, focal motor deficits in 13, visual loss in 12, seizures in 10, diplopia in 7, and papilledema in 9 patients. 28 patients had the following predisposing conditions: HIV in 15, diabetes in 8, corticosteroid in 2 and alcohol, immunosuppression, neutropenia and analgesic abuse in 1 patient each. On CT or MRI scan, 5 patients had meningeal enhancement, 7 sinusitis, 10 each granuloma and infarction, 4 hydrocephalous and 1 cerebral venous sinus thrombosis. 28 patients had cryptococcal meningitis, 7 zygomycosis, 2 aspergillosis and 1 each candida and phaeohyphomycosis. Death was related to the type of fungal infection; all patients with zygomycosis and candida infection died. Rhinocerebral form of fungal infection due to zygomycetes has poorer survival compared to meningitis group which was mainly due to cryptococcal infection.

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References

  1. Drouhet E (2005) Historical introduction: evolution of knowledge of the fungi and mycoses from Hippocrates to the twenty first century. In: Merz WG, Hay RJ (eds) Topley and Wilson’s medical mycology. Hodder Arnold, Washington, D.C., pp 3–40

  2. Misra UK, Kalita J, Verma A (2008) Infections of the nervous system: fungal infections in neurology in clinical practice, 5th edn. Bradley WG, pp 1489–1502

  3. Walsh TJ, Hier DB, Caplan LR (1985) Fungal infections of the central nervous system: comparative analysis of risk factors and clinical signs in 57 patients. Neurology 35:1654–1657

    Article  PubMed  CAS  Google Scholar 

  4. Dubey A, Patwardhan RV, Sampth S, Santosh V, Kolluri S, Nanda A (2005) Intracranial fungal granuloma: analysis of 40 patients and review of the literature. Surg Neurol 63:254–260

    Article  PubMed  Google Scholar 

  5. Sundaram C, Umabala P (2006) Pathology of fungal infections of the central nervous system: 17 years’ experience from Southern India. Histopathology 49:396–405

    Article  PubMed  CAS  Google Scholar 

  6. Sharma BS, Khosla VK, Kak VK et al (1997) Intracranial fungal granuloma. Surg Neurol 47:489–497

    Article  PubMed  CAS  Google Scholar 

  7. Mylonakis E, Paliou M, Sax PE, Skolnik PR, Baron MJ, Rich JD (2000) Central nervous system aspergillosis in patients with human immunodeficiency virus infection. Report of 6 cases and review. Medicine (Baltimore) 79:269–280

    Article  CAS  Google Scholar 

  8. Jellinger KA, Setinek U, Drlicek M, Böhm G, Steurer A, Lintner F (2000) Neuropathology and general autopsy findings in AIDS during the last 15 years. Acta Neuropathol 100:213–220

    Article  PubMed  CAS  Google Scholar 

  9. Coates M, Wilson J (2001) Central nervous system aspergillus infection complicating renal transplantation. Australas Radiol 45:338–342

    Article  PubMed  CAS  Google Scholar 

  10. Baddley JW, Salzman D, Pappas PG (2002) Fungal brain abscess in transplant recipients: epidemiologic, microbiologic, and clinical features. Clin Transplant 16(6):419–424

    Article  PubMed  Google Scholar 

  11. Mitchell TG, Perfect JR (1995) Cryptococcosis in the era of AIDS—100 years after the discovery of Cryptococcus neoformans. Clin Microbiol Rev 8:515–548

    PubMed  CAS  Google Scholar 

  12. Chakrabarti A, Sharma A, Sood A et al (2000) Changing scenario of cryptococcosis in a tertiary care hospital in north India. Indian J Med Res 112:56–60

    PubMed  CAS  Google Scholar 

  13. Banerjee U, Datta K, Majumdar T, Gupta K (2001) Cryptococcosis in India: the awakening of a giant? Med Mycol 39:51–67

    PubMed  CAS  Google Scholar 

  14. Khanna N, Chandramuki A, Desai A, Ravi V (1996) Cryptococcal infections of the central nervous system: an analysis of predisposing factors, laboratory findings and outcome in patients from South India with special reference to HIV infection. J Med Microbiol 45:376–379

    Article  PubMed  CAS  Google Scholar 

  15. Lan SH, Chang WN, Lu CH, Lui CC, Chang HW (2001) Cerebral infarction in chronic meningitis: a comparison of tuberculous meningitis and cryptococcal meningitis. QJM 94:247–253

    Article  PubMed  CAS  Google Scholar 

  16. Perfect JR, Cox GM (2001) Cryptococcosis. In: Merz WG, Hay RJ (eds) Topley and Wilson’s medical mycology. Perfect JR, Cox GM, pp 637–658

  17. Karabinis A, Hill C, Leclercq B, Tancrède C, Baume D, Andremont A (1988) Risk factors for candidemia in cancer patients: a case–control study. J Clin Microbiol 26:429–432

    PubMed  CAS  Google Scholar 

  18. Gottfredsson M, Perfect JR (2000) Fungal meningitis. Semin Neurol 20:307–322

    Article  PubMed  CAS  Google Scholar 

  19. Walsh TJ, Anaissie EJ, Denning DW et al (2008) Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 46:327–360

    Article  PubMed  CAS  Google Scholar 

  20. Prabhu RM, Patel R (2004) Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect 10(Suppl 1):31–47

    Article  PubMed  Google Scholar 

  21. Gonzalez CE, Rinaldi MG, Sugar AM (2002) Zygomycosis. Infect Dis Clin North Am 16:895–914

    Article  PubMed  Google Scholar 

  22. Wingard JR, Kubilis P, Lee L et al (1999) Clinical significance of nephrotoxicity in patients treated with amphotericin B for suspected or proven aspergillosis. Clin Infect Dis 29:1402–1407

    Article  PubMed  CAS  Google Scholar 

  23. Girois SB, Chapuis F, Decullier E, Revol BG (2005) Adverse effects of antifungal therapies in invasive fungal infections: review and meta-analysis. Eur J Clin Microbiol Infect Dis 24:119–130

    Article  PubMed  CAS  Google Scholar 

  24. Deray G (2002) Amphotericin B nephrotoxicity. J Antimicrob Chemother 49(Suppl 1):37–41

    Article  PubMed  CAS  Google Scholar 

  25. Groll AH, Giri N, Petraitis V et al (2000) Comparative efficacy and distribution of lipid formulations of amphotericin B in experimental Candida albicans infection of the central nervous system. J Infect Dis 182:274–282

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, 226014, India

    Ritu Agarwal, Jayantee Kalita & Usha Kant Misra

  2. Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

    Rungmei S. K. Marak

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  1. Ritu Agarwal
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  2. Jayantee Kalita
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  3. Rungmei S. K. Marak
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  4. Usha Kant Misra
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Correspondence to Usha Kant Misra.

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Agarwal, R., Kalita, J., Marak, R.S.K. et al. Spectrum of fungal infection in a neurology tertiary care center in India. Neurol Sci 33, 1305–1310 (2012). https://doi.org/10.1007/s10072-012-0932-1

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  • DOI: https://doi.org/10.1007/s10072-012-0932-1

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