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Fungal Diseases
Santhosh Gaddikeri, MD; Miral D. Jhaveri, MD, MBA
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Coccidioidomycosis, histoplasmosis, blastomycosis, candidiasis, aspergillosis, mucormycosis
            • Definitions

              • Fungal infections of CNS are potentially lethal conditions that can involve meninges, brain, and spinal cord
              • Common fungi causing CNS infection
                • Yeasts: Candida and Cryptococcus
                • Dimorphic fungi: Coccidioides, Histoplasma, Blastomyces
                • Molds: Aspergillus and mucormycetes
              • Coccidioidomycosis
                • Sporadic, relatively common
              • Histoplasmosis
                • Common
              • Blastomycosis
                • Rare, sporadic, generally affects lungs/skin
              • Invasive CNS fungal infections
                • Patients usually immunocompromised
                • Agents
                  • Hyphae: Aspergillosis, mucormycosis
                  • Pseudohyphae/yeast: Candidiasis

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Jackson NR et al: Central nervous system infections due to coccidioidomycosis. J Fungi (Basel). 5(3), 2019
                                            2. Góralska K et al: Neuroinfections caused by fungi. Infection. 46(4):443-59, 2018
                                            3. Schwartz S et al: Advances in the diagnosis and treatment of fungal infections of the CNS. Lancet Neurol. 17(4):362-72, 2018
                                            4. Orlowski HLP et al: Imaging spectrum of invasive fungal and fungal-like infections. Radiographics. 37(4):1119-34, 2017
                                            5. Murthy JM et al: Fungal infections of the central nervous system. Handb Clin Neurol. 121:1383-401, 2014
                                            6. Saini J et al: Intracranial infections: key neuroimaging findings. Semin Roentgenol. 49(1):86-98, 2014
                                            7. Starkey J et al: MRI of CNS fungal infections: review of aspergillosis to histoplasmosis and everything in between. Clin Neuroradiol. 24(3):217-30, 2014
                                            8. Lammering JC et al: Imaging spectrum of CNS coccidioidomycosis: prevalence and significance of concurrent brain and spinal disease. AJR Am J Roentgenol. 200(6):1334-46, 2013
                                            9. Mathur M et al: Fungal infections of the central nervous system. Neuroimaging Clin N Am. 22(4):609-32, 2012
                                            10. Tahin B et al: [Manifestations of systemic mycoses and related infections in the central nervous system.] Orv Hetil. 150(29):1367-74, 2009
                                            11. Berkeley JL et al: Fatal immune reconstitution inflammatory syndrome with human immunodeficiency virus infection and Candida meningitis: case report and review of the literature. J Neurovirol. 14(3):267-76, 2008
                                            12. Luthra G et al: Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol. 28(7):1332-8, 2007
                                            13. Redmond A et al: Fungal infections of the central nervous system: a review of fungal pathogens and treatment. Neurol India. 55(3):251-9, 2007
                                            14. Zivković S: Neuroimaging and neurologic complications after organ transplantation. J Neuroimaging. 17(2):110-23, 2007
                                            15. da Rocha AJ et al: Granulomatous diseases of the central nervous system. Top Magn Reson Imaging. 16(2):155-87, 2005
                                            16. Gaviani P et al: Diffusion-weighted imaging of fungal cerebral infection. AJNR Am J Neuroradiol. 26(5):1115-21, 2005
                                            17. Komatsu H et al: Molecular diagnosis of cerebral aspergillosis by sequence analysis with panfungal polymerase chain reaction. J Pediatr Hematol Oncol. 26(1):40-4, 2004
                                            18. Revankar SG et al: Primary central nervous system phaeohyphomycosis: a review of 101 cases. Clin Infect Dis. 38(2):206-16, 2004
                                            19. Wong AM et al: Magnetic resonance imaging of carotid artery abnormalities in patients with sphenoid sinusitis. Neuroradiology. 46(1):54-9, 2004
                                            20. Bradsher RW et al: Blastomycosis. Infect Dis Clin North Am. 17(1):21-40, vii, 2003
                                            21. Brandt ME et al: Epidemiology, clinical manifestations, and therapy of infections caused by dematiaceous fungi. J Chemother. 15 Suppl 2:36-47, 2003
                                            22. Schelenz S et al: Candidaemia in a London teaching hospital: analysis of 128 cases over a 7-year period. Mycoses. 46(9-10):390-6, 2003
                                            23. Chowfin A et al: Recurrent blastomycosis of the central nervous system: case report and review. Clin Infect Dis. 30(6):969-71, 2000
                                            24. Erly WK et al: Disseminated coccidioidomycosis complicated by vasculitis: a cause of fatal subarachnoid hemorrhage in two cases. AJNR Am J Neuroradiol. 20(9):1605-8, 1999
                                            25. Lai PH et al: Disseminated miliary cerebral candidiasis. AJNR Am J Neuroradiol. 18(7):1303-6, 1997
                                            26. Desai SP et al: Disseminated CNS histoplasmosis. AJNR Am J Neuroradiol. 12(2):290-2, 1991
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Coccidioidomycosis, histoplasmosis, blastomycosis, candidiasis, aspergillosis, mucormycosis
                                                      • Definitions

                                                        • Fungal infections of CNS are potentially lethal conditions that can involve meninges, brain, and spinal cord
                                                        • Common fungi causing CNS infection
                                                          • Yeasts: Candida and Cryptococcus
                                                          • Dimorphic fungi: Coccidioides, Histoplasma, Blastomyces
                                                          • Molds: Aspergillus and mucormycetes
                                                        • Coccidioidomycosis
                                                          • Sporadic, relatively common
                                                        • Histoplasmosis
                                                          • Common
                                                        • Blastomycosis
                                                          • Rare, sporadic, generally affects lungs/skin
                                                        • Invasive CNS fungal infections
                                                          • Patients usually immunocompromised
                                                          • Agents
                                                            • Hyphae: Aspergillosis, mucormycosis
                                                            • Pseudohyphae/yeast: Candidiasis

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Angiographic Findings

                                                              • Nuclear Medicine Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Jackson NR et al: Central nervous system infections due to coccidioidomycosis. J Fungi (Basel). 5(3), 2019
                                                                                      2. Góralska K et al: Neuroinfections caused by fungi. Infection. 46(4):443-59, 2018
                                                                                      3. Schwartz S et al: Advances in the diagnosis and treatment of fungal infections of the CNS. Lancet Neurol. 17(4):362-72, 2018
                                                                                      4. Orlowski HLP et al: Imaging spectrum of invasive fungal and fungal-like infections. Radiographics. 37(4):1119-34, 2017
                                                                                      5. Murthy JM et al: Fungal infections of the central nervous system. Handb Clin Neurol. 121:1383-401, 2014
                                                                                      6. Saini J et al: Intracranial infections: key neuroimaging findings. Semin Roentgenol. 49(1):86-98, 2014
                                                                                      7. Starkey J et al: MRI of CNS fungal infections: review of aspergillosis to histoplasmosis and everything in between. Clin Neuroradiol. 24(3):217-30, 2014
                                                                                      8. Lammering JC et al: Imaging spectrum of CNS coccidioidomycosis: prevalence and significance of concurrent brain and spinal disease. AJR Am J Roentgenol. 200(6):1334-46, 2013
                                                                                      9. Mathur M et al: Fungal infections of the central nervous system. Neuroimaging Clin N Am. 22(4):609-32, 2012
                                                                                      10. Tahin B et al: [Manifestations of systemic mycoses and related infections in the central nervous system.] Orv Hetil. 150(29):1367-74, 2009
                                                                                      11. Berkeley JL et al: Fatal immune reconstitution inflammatory syndrome with human immunodeficiency virus infection and Candida meningitis: case report and review of the literature. J Neurovirol. 14(3):267-76, 2008
                                                                                      12. Luthra G et al: Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol. 28(7):1332-8, 2007
                                                                                      13. Redmond A et al: Fungal infections of the central nervous system: a review of fungal pathogens and treatment. Neurol India. 55(3):251-9, 2007
                                                                                      14. Zivković S: Neuroimaging and neurologic complications after organ transplantation. J Neuroimaging. 17(2):110-23, 2007
                                                                                      15. da Rocha AJ et al: Granulomatous diseases of the central nervous system. Top Magn Reson Imaging. 16(2):155-87, 2005
                                                                                      16. Gaviani P et al: Diffusion-weighted imaging of fungal cerebral infection. AJNR Am J Neuroradiol. 26(5):1115-21, 2005
                                                                                      17. Komatsu H et al: Molecular diagnosis of cerebral aspergillosis by sequence analysis with panfungal polymerase chain reaction. J Pediatr Hematol Oncol. 26(1):40-4, 2004
                                                                                      18. Revankar SG et al: Primary central nervous system phaeohyphomycosis: a review of 101 cases. Clin Infect Dis. 38(2):206-16, 2004
                                                                                      19. Wong AM et al: Magnetic resonance imaging of carotid artery abnormalities in patients with sphenoid sinusitis. Neuroradiology. 46(1):54-9, 2004
                                                                                      20. Bradsher RW et al: Blastomycosis. Infect Dis Clin North Am. 17(1):21-40, vii, 2003
                                                                                      21. Brandt ME et al: Epidemiology, clinical manifestations, and therapy of infections caused by dematiaceous fungi. J Chemother. 15 Suppl 2:36-47, 2003
                                                                                      22. Schelenz S et al: Candidaemia in a London teaching hospital: analysis of 128 cases over a 7-year period. Mycoses. 46(9-10):390-6, 2003
                                                                                      23. Chowfin A et al: Recurrent blastomycosis of the central nervous system: case report and review. Clin Infect Dis. 30(6):969-71, 2000
                                                                                      24. Erly WK et al: Disseminated coccidioidomycosis complicated by vasculitis: a cause of fatal subarachnoid hemorrhage in two cases. AJNR Am J Neuroradiol. 20(9):1605-8, 1999
                                                                                      25. Lai PH et al: Disseminated miliary cerebral candidiasis. AJNR Am J Neuroradiol. 18(7):1303-6, 1997
                                                                                      26. Desai SP et al: Disseminated CNS histoplasmosis. AJNR Am J Neuroradiol. 12(2):290-2, 1991