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Author Ramesha, K. N. ♦ Kate, M. P. ♦ Kesavadas, C. ♦ Radhakrishnan, V. V. ♦ Nair, S. ♦ Thomas, S. V.
Source Sree Chitra Tirunal Institute for Medical Sciences & Technology
Content type Text
Publisher Annals of Indian Academy of Neurology
File Format PDF
Language English
Subject Domain (in DDC) Technology ♦ Medicine & health ♦ Diseases
Subject Domain (in MeSH) Bacterial Infections and Mycoses ♦ Nervous System Diseases ♦ Immune System Diseases ♦ Diseases
Subject Keyword Neurology
Abstract Objective: To describe the clinical, radiological, and cerebrovascular fluid (CSF) findings and the outcome of microbiologically or histopathologically proven fungal infections of the central nervous system (CNS) in HIV-negative patients. Methodology and Results: We identified definite cases of CNS mycosis by screening the medical records of our institute for the period 2000-2008. The clinical and imaging details and the outcome were abstracted from the medical records and entered in a structured proforma. There were 12 patients with CNS mycosis (i.e., 2.7% of all CNS infections treated in this hospital); six (50%) had cryptococcal infection, three (25%) had mucormycosis, and two had unclassified fungal infection. Four (33%) of them had diabetes as a predisposing factor. The common presentations were meningoencephalitis (58%) and polycranial neuritis (41%). Magnetic resonance imaging revealed hydrocephalus in 41% and meningeal enhancement in 25%, as well as some unusual findings such as subdural hematoma in the bulbocervical region, carpeting lesion of the base of the skull, and enhancing lesion in the cerebellopontine angle. The CSF showed pleocytosis (66%), hypoglycorrhachia (83%), and elevated protein levels (100%). The diagnosis was confirmed by meningocortical biopsy (in three cases), paranasal sinus biopsy (in four cases), CSF culture (in three cases), India ink preparation (in four cases), or by cryptococcal polysaccharide antigen test (in three cases). Out of the ten patients for whom follow-up details were available, six patients recovered with antifungal medications (amphotericin B, 1 mg/kg/day for the minimum period of 6 weeks) and/or surgical treatment. Four patients expired (only one of them had received antifungal therapy). Conclusions: Most patients with CNS mycosis recover with appropriate therapy, but the diagnosis and management of these rare infections remains a challenge to clinicians.
Education Level UG and PG
Learning Resource Type Article
Educational Framework Medical Council of India (MCI)
Journal ANNALS OF INDIAN ACADEMY OF NEUROLOGY
Volume Number 13
Issue Number 2
Page Count 5
Starting Page 112
Ending Page 116