Abstract
INTRODUCTION:Fungal infections of the central nervous system are increasingly frequent due to the increase in populations at risk. They are mainly opportunistic, and uncommon in non-immunocompromise patients.
CASE PRESENTATION:A 28-year-old man, without a significant medical and surgical history, consulted the emergency department for refractory headache, accompanied by fever and meningeal signs, a lumbar puncture lead to the subsequent microbiological finding of Candida glabrata in cerebrospinal fluid. Immunocompromise was ruled out, including HIV coinfection, collagen, neoplasms and even lack of immunization during childhood.
DISCUSSION:About 70,000 formally described fungal species are estimated, of which 300 could show virulence in humans, with multiple forms of presentation in the central nervous system, mainly meningitis, encephalitis, hydrocephalus, brain abscess and stroke, all conditioned due to a predisposing factor or immune status of the host, even considering some degree of immunodeficiency on Toll like receptors, which limit the binding to PAMPs and subsequent progression of infection at the height of the CNS.
References
Góralska K, Blaszkowska J, Dzikowiec M. Neuroinfections caused by fungi. Infection. 2018;46(4):443-459. DOI: 10.1007/s15010-018-1152-2.
Murthy JM, Sundaram C. Fungal infections of the central nervous system. Handb Clin Neurol. 2014;121:1383-401. DOI: 10.1016/B978-0-7020-4088-7.00095-X.
Bongomin F, Gago S, Oladele RO, Denning DW Global and multi-national prevalence of fungal diseases-estimate precision. J Fungi (Basel). 2017;3(4). pii: E57. DOI: 10.3390/jof3040057.
Brumble LM, Reza MB, Dhakal LP, Cruz G, Abu Saleh OM, Heckman MG, et al. Fungal infections of the central nervous system: clinical, radiographic and laboratory manifestations. J Microbiol Exp. 2017;5:00167.
Gavito-Higuera J, Mullins CB, Ramos-Duran L, Olivas Chacon CI, Hakim N, Palacios E. Fungal infections of the central nervous system: a pictorial review. J Clin Imaging Sci. 2016;6:24. DOI: 10.4103/2156-7514.184244.
McCarthy M, Rosengart A, Schuetz AN, Kontoyiannis DP, Walsh TJ. Mold infections of the central nervous system. N Engl J Med. 2014;371(2):150-60. DOI: 10.1056/NEJMra1216008.
Alves de Medeiros AK, Lodewick E, Bogaert DJ, Haerynck F, Van Daele S, et al. Chronic and invasive fungal infections in a family with CARD9 deficiency. J Clin Immunol. 2016;36(3):204-9. DOI: 10.1007/s10875-016-0255-8.
Corvilain E, Casanova JL, Puel A. Inherited CARD9 deficiency: invasive disease caused by ascomycete fungi in previously healthy children and adults. J Clin Immunol. 2018;38(6):656-693. DOI: 10.1007/s10875-018-0539-2.
Vinh DC. Insights into human antifungal immunity from primary immunodeficiencies. Lancet Infect Dis. 2011;11(10):780-92. DOI: 10.1016/S1473-3099(11)70217-1.
Glocker EO, Hennigs A, Nabavi M, Schàffer AA, Woellner C, Salzer U, et al. A homozygous CARD9 mutation in a family with susceptibility to fungal infections. N Engl J Med. 2009;361(18):1727-35. DOI: 10.1056/NEJMoa0810719.
Drewniak A, Gazendam RP, Tool AT, van Houdt M, Jansen MH, van Hamme JL, et al. Invasive fungal infection and impaired neutrophil killing in human CARD9 deficiency Blood. 2013;121(13):2385-92. DOI: 10.1182/blood-2012-08-450551.
Gavino C, Cotter A, Lichtenstein D, Lejtenyi D, Fortin C, LegaultC, et al. CARD9 deficiency and spontaneous central nervous system candidiasis: complete clinical remission with GM-CSF therapy. Clin Infect Dis. 2014;59(1):81-4. DOI:10.1093/cid/ciu215.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.