Purpose: Fungal infections of the central nervous system (CNS) are potentially
lethal conditions with high morbidity and mortality. In this review, we
summarise the most common clinical manifestations, diagnostic methods,
and treatment strategies for intracranial fungal infection at two tertiary care
teaching hospitals. Material and methods: Prospective hospital study is carried
out at Department of Neurosurgery; Assiut and Suhaj University Hospitals
between January2010 to January 2018 (Minimum 12-months follow-up).
Radiographs and hospital data of 74 patients with proven intracranial fungal
infections were gathered and analyzed. There were no exclusion criteria: age,
gender, clinical presentations, immunity status, radiological findings, laboratory,
and microbiological data, types of management and outcome. In surgically
treated patients, diagnosis was confirmed by pathologic evaluation. Gathered
data were coded and entered into a computer and analyzed using SPSS
version 22. Results: The greatest number of the patients had 40 to 60 years
old (49; 66%) and the mean age was 44 years. There was an overwhelming
male patient’s ranged preponderance 66%; 49 cases. Sixty-three patients
(85%) were immunosuppressed; 11 cases (15%) were immunocompetent. The
most common causes of immunosuppression were diabetes 27 patients; 43%,
on chemotherapeutic agents 19 patients; 31%, on corticosteroid 16 patients;
25% and AIDS in one patient; 1%. Five different fungal types were identified
but Cryptococcus spp. was the most common cause of CNS fungal infection,
occurring in 39 patients (53%). This was followed by Candida spp. in 14 patients
(19%), Aspergillus in 11 patients (15%), Blastomyces in 7 patients (9%)
and Coccidiosis in 3 patients (4%). Headache was the most common presenting
symptom, occurring in 33 patients (45%). Other relatively common symptoms were nausea or vomiting 11 patients (15%), fever 10 patients;
(13%), seizures 9 patients (12%), acute mental status changes 8 patients;
(11%) and stroke like Symptoms 3patients (4%). Different surgical procedures
were done. Stereotactic biopsy is in 19 patients (deep; located in an
eloquent region of the brain or multiple small lesion) or excision in 38 patients
(cortical, relatively accessible regions of the brain), and CSF shunting in
17 patients. All patients received parenteral and, in some cases, oral antifungal
chemotherapy in addition to surgical therapy. Overall mortality was
52.7% (39 deaths). An additional 8 surviving patients exhibited permanent
morbidity due to neurological deficits and seizure disorders. Conclusion:
This prospective population study demonstrates an insight into the intracranial
fungal infection and management. CNS fungal infections have increased
in frequency, particularly in immunocompromised patients; most infections
are caused by Cryptococcus spp. Diabetes was the most common
cause of immunosuppression and headache was the most common symptom
at presentation. CNS fungal infection is still associated with a high mortality
and morbidity. Prompt diagnosis; early and appropriate medical and surgical
management are fundamental to optimize the outcome.