• Sundaram Challa


Central nervous system (CNS) aspergillosis is rare and constitutes 10–20% of invasive aspergillosis. CNS aspergillosis is reported in immunosuppressed hosts with dissemination from the lung or heart by hematogenous spread, usually by Aspergillus fumigatus, whereas it is reported in immunocompetent hosts by contiguous spread from sinus, ear, or orbit, usually by A. flavus. Environmental factors and virulence factors of the pathogen are implicated in the pathogenesis. Neutropenia and administration of corticosteroids are important risk factors in immunosuppressed hosts, whereas hot and humid climate with constant exposure to high inoculums of pathogen predisposes to infection in immunocompetent hosts. Though CNS is protected by blood-brain barrier and blood-cerebrospinal fluid barrier and innate immunity, the pathogen evades the immune attack by its virulence factors and secretes proteases and toxins to facilitate invasion and growth in the host. The pathology depends on the immune status of the host, route of spread, and virulence of the pathogen. The pathology in disseminated disease is infarction with or without hemorrhage and single/multiple abscesses, whereas it is granuloma with extensive fibrosis in sinocranial aspergillosis. Meningitis and mycotic aneurysm are uncommon. Early diagnosis is important for timely and appropriate treatment. Histopathology and culture have less sensitivity for diagnosis but are still recommended where tissue can be obtained, till molecular tests are widely available. Galactomannan test with validated polymerase chain reaction is useful in disseminated disease, but still not validated for routine use. This review focuses on the host pathogen interactions, pathology, and diagnosis of CNS aspergillosis.


Central nervous system Aspergillosis Disseminated disease Immune status Risk factors Pathogenesis Pathology Diagnosis 



Broncoalveolar lavage


Blood-brain barrier




Chronic granulomatous disease


Central nervous system


Complement receptor


Cerebrospinal fluid


Extracellular matrix


Formalin-fixed parafin embedded






Gomori’s methenamine silver


Hematoxylin and eosin


Hematopoietic stem cell transplant


Invasive aspergillosis


Intracranial space occupying lesion




Pathogen-associated molecular pattern


Polymerase chain reaction


Periodic acid-Schiff




Reactive oxygen species


Toll-like receptors


Tumor necrosis factor



The author, who was former Dean and Senior Professor of Pathology at Nizam’s Institute of Medical Sciences, Hyderabad, gratefully acknowledges all the colleagues, students, and technical staff for their contribution.


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sundaram Challa
    • 1
  1. 1.Basavatarakam Indo-American Cancer Hospital & Research InstituteHyderabadIndia

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