Fungal Infections of the Central Nervous System
Fungal infections of the central nervous system (CNS) are life-threatening conditions that generally involve an immunosuppressive event. Many of these infections occur sporadically in the course of a serious underlying disease. However, outbreaks of CNS fungal disease may occur, as exemplified by the Cryptococcus gattii infections in British Columbia and the northwest United States, by iatrogenic paraspinal infection after injection of contaminated corticosteroids, and by the association with new anticancer agents such as ibrutinib. The clinician must be aggressive in diagnosing these infections and then use either robust treatment guidelines or simply expert opinion to determine appropriate management. These serious infections remain a major challenge in the clinical management of a vulnerable host population or when they occur in an apparently normal host.
