Fungal Meningitis

Magnús Gottfredsson; John R. Perfect

doi:10.1055/s-2000-9394

Seminars in Neurology, Inhaltsverzeichnis

Semin Neurol 2000; Volume 20(Number 03): 307-322
DOI: 10.1055/s-2000-9394

Fungal Meningitis

Magnús Gottfredsson^1,2 , John R. Perfect²

¹Department of Medicine, Infectious Diseases Section, Landspitalinn, National University Hospital, Reykjavik Iceland
²Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina

Abstract

ABSTRACT

Fungi provide many benefits to humans. However, some of these fungi have the ability to become human pathogens. All the major fungal pathogens can produce meningitis. From the common cryptococcal meningitis to the rare fungal meningitis caused by a dimorphic or filamentous fungus, medical issues are discussed in this review on a fungus-specific basis. Both primary (Cryptococcus, Blastomyces, Histoplasma, Coccidioides, and other dimorphic fungi) and secondary (Aspergillus, Candida, and a series of molds) fungal pathogens can produce life-threatening central nervous system infections. These infections require immediate and precise diagnosis and carefully selected management strategies to optimize outcomes. In this review, we examine the epidemiology, pathogenesis, clinical manifestations, and treatment for fungal meningitis in all the major fungal groups.

KEYWORD

Meningitis - fungi - central nervous system infections

Volltext

Referenzen

REFERENCES

1 Perfect J R, Durack D T. Fungal meningitis. In: Scheld WM, Whitley RJ, Durack DT, eds. Infections of the Central Nervous System New York: Lippincott-Raven 1997: 721
2 Takeda S, Wakabayashi K, Yamazaki K, Miyakawa T, Arai H. Intracranial fungal aneurysm caused by Candida endocarditis. Clin Neuropathol . 1998; 17 199
3 Mitchell T G, Perfect J R. Cryptococcosis in the era of AIDS 100 years after the discovery of Crypttococcus neoformans Clin Microbiol Rev . 1995; 8 515
4 Sabetta J R, Andriole V T. Cryptococcal infection of the central nervous system. Med Clin North Am . 1985; 69 333
5 Perfect J R, Durack D T, Gallis H A. Cryptococcemia. Medicine (Baltimore) . 1983; 62 98
6 Perfect J R. Cryptococcosis. Infect Dis Clin North Am . 1989; 3 77
7 Bouza E, Dreyer J S, Hewitt W L, Meyer R D. Coccidioidal meningitis: an analysis of thirty-one cases and review of the literature. Medicine (Baltimore) . 1981; 60 139
8 Goodwin Jr R A, Shapiro J L, Thurman G H, Thurman S S, Des P rez. Disseminated histoplasmosis: clinical and pathologic correlations. Medicine (Baltimore) . 1980; 59 1
9 Karalakulasingam R, Arora K K, Adams G, Serratoni F, Martin D G. Meningoencephalitis caused by Histoplasma capsulatum Arch Intern Med . 1976; 136 217
10 Cooper Jr R A, Goldstein E. Histoplasmosis of the central nervous system: report of two cases and review of the literature. Am J Med . 1963; 35 45
11 Tynes B S, Crutcher J C, Utz J P. Histoplasma meningitis Ann Intern Med . 1963; 59 619
12 Wheat L J, Batteiger B E, Sathapatayavongs B. Histoplasma capsulatum infections of the central nervous system. Medicine (Baltimore) . 1990; 69 244
13 Gonyea E F. The spectrum of primary blastomycotic meningitis: a review of central nervous system blastomycosis. Ann Neurol . 1978; 3 26
14 Buechner H A, Clawson C. Blastomycosis of the central nervous system: II. A report of nine cases from the Veterans Administration Cooperative Study. Am Rev Respir Dis . 1967; 95 820
15 Pereira W C, Raphael A, Tenut R A. Localizacoa encefalico da blastomicose sul-americana: consideraooes a proposito de 9 casos. Arq Neuropsiquiatr . 1965; 23 113
16 Ewing G E, Bosl G J, Peterson P K. Sporothrix schenckii meningitis in a farmer with Hodgkin's disease. Am J Med . 1980; 68 455
17 Freeman J W, Ziegler D K. Chronic meningitis caused by Sporothrix schenckii Neurology . 1977; 27 989
18 Klein R C, Ivens M S, Seabury J H, Dascomb H E. Meningitis due to Sporotrichum schenckii Arch Intern Med . 1966; 118 145
19 Benham R W, Georg L K. Allescheria boydii causative agent in a case of meningitis. J Invest Dermatol . 1948; 10 99
20 Yoo D, Lee W HS, Kwon-Chung K J. Brain abscess due to Pseudallescheria boydii associated with primary non-Hodgkin's lymphoma of the central nervous system: a case report and literature review. Rev Infect Dis . 1985; 7 272
21 Selby R. Pachymeningitis secondary to Allescheria boydii: Case report. J Neurosurg . 1972; 36 225
22 Dworzack D L, Clark R B, Padgett P J. New causes of pneumonia, meningitis, and disseminated infections associated with immersion. Infect Control Hosp Epidemiol . 1987; 1 615
23 Bayer A S, Edwards Jr J E, Seidel J S, Guze L B. Candida meningitis: Report of seven cases and review of the English literature. Medicine (Baltimore) . 1976; 55 477
24 Chadwick D W, Hartley E, Mackinnon D M. Meningitis caused by Candida tropicalis Arch Neurol . 1980; 37 175
25 Chattopadhyay B. Candida tropicalis meningitis: a case report. J Laryngol Otol . 1981; 95 1149
26 Buchs S, Pfister P. Candida meningitis: course, prognosis and mortality before and after introduction of the new antimycotics. Mykosen . 1983; 26 73
27 Parker Jr J C, McCloskey J J, Lee R S. The emergence of candidosis: the dominant postmortem cerebral mycosis. Am J Clin Pathol . 1978; 70 31
28 Walsh T J. Trichosporonosis. Infect Dis Clin North Am . 1989; 3 43
29 Watson K C, Kallichurum S. Brain abscess due to Trichosporon cutaneum J Med Microbiol . 1970; 3 191
30 Surmont I, Vergauwen B, Marcelis L, Verbist L, Verhoef G, Boogaerts M. First report of chronic meningitis caused by Trichosporon beigelii Eur J Clin Microbiol . 1990; 9 226
31 Ohashi Y. On a rare disease due to Alternaria tenuis nees Tohoku J Exp Med . 1960; 72 78
32 Pore R S, Chen J. Meningitis caused by Rhodotorula Sabouraudia . 1976; 14 331
33 Huttova M, Kralinsky K, Horn J. Prospective study of nosocomial fungal meningitis in children: report of 10 cases. Scand J Infect Dis . 1998; 30 485
34 Ahmed A, Aggarwal M, Chiu R, Ramratnam B, Rinaldi M, Flanigan T P. A fatal case of Rhodotorula meningitis in AIDS. Med Health . 1998; 81 22
35 Gyaurgieva O H, Bogomolova T S, Gorshkova G I. Meningitis caused by Rhodotorula rubra in an HIV-infected patient. J Med Vet Mycol . 1996; 34 357
36 Fincher R ME, Fisher J F, Lovell R D, Newman C L, Espinel-Ingroff A, Shadomy H J. Infection due to the fungus Acremonium (Cephalosporium) Medicine (Baltimore) . 1991; 70 398
37 Kremery Jr V, Mateicka F, Grausoua S, Kunova A, Hazen J. Invasive infections due to Clavispora lusitaniae FEMS Immunol Med Microbiol . 1999; 23 75
38 Fuste F J, Ajello L, Threlkeld R, Henry Jr J E. Drechslera hawaiiensis: causative agent of a fatal fungal meningo-encephalitis. Sabouraudia . 1973; 11 59
39 Mukerji S, Patwardhan J R, Gadgil R K. Bacterial and mycotic infection of the brain. Indian J Med Sci . 1971; 25 791
40 Malassezia A S, Komiyama A, Hasegawa O. Fungal meningitis caused by a Malassezia species masquerading as painful ophthalmoplegia. Clin Neurol (Tokyo) . 1993; 33 462
41 Watanabe S, Hironaga M. An atypical isolate of Scedoporium apiospermum from a purulent meningitis in man. Sabouraudia . 1981; 19 209
42 Chaves-Batista A, Mala J A, Singer P. Basidioneuromycosis in man. Inst de Micologia Publicacao No 42, Universidade de Recife, Brasil, 1955: 53
43 Girmenia C, Micozzi A, Venditti M. Fluconazole treatment of Blastoschizomyces capitatus meningitis in an allogeneic bone marrow recipient. Eur J Clin Microbiol Infect Dis . 1991; 10 752
44 Fagerburg R, Suh B, Buckley H R. Cerebrospinal fluid shunt colonization and obstruction by Paecilomyces varoti J Neurosurg . 1981; 54 257
45 Kremery Jr V, Spanik S, Denisovicoua A, Jesenska Z, Blahoua M. Aureobasidium mansoni meningitis in a leukemia patient successfully treated with amphotericin B. Chemotherapy . 1994; 40 70
46 Baena Luna M R, Munoz Garcia J, Grancha Bertolin C, Sanz Garcia M. Pneumocystis carinii en liquido cefalorraguideo. Ann Med Interne (Paris) . 1998; 15 265
47 Epelbaum S, Laurent C, Morin G, Berquin P, Piussan C. Failure of fluconazole treatment in Candida meningitis. J Pediatr . 1993; 123 168
48 Moore M, Russell W O, Sachs E. Chronic leptomeningitis and ependymitis caused by Ustilago, probably U. zeae (corn smut): ustilagomycosis, second reported instance of human infection. Am J Pathol . 1946; 22 761
49 Brenier-Pinchart M P, Leclercq P, Mallie M. Candida meningitis possibly resulting from a harpoon injury. Eur J Clin Microbiol Infect Dis . 1999; 18 454
50 Couch J R, Abdou N I, Sagava A. Histoplasma meningitis with hyperactive suppressor T cells in cerebrospinal fluid. Neurology . 1978; 28 119
51 White M, Cirrincione C, Blevins A, Armstrong D. Cryptococcal meningitis with AIDS and patients with neoplastic disease. J Infect Dis . 1992; 165 960
52 Peacock J E, McGinnis M R, Cohen M S. Persistent neutrophilic meningitis. Medicine (Baltimore) . 1984; 63 379
53 McGinnis M R. Detection of fungi in cerebrospinal fluid. Am J Med . 1983; 75 129
54 Gonyea E F. Cisternal puncture and cryptococcal meningitis. Arch Neurol . 1973; 28 200
55 Body B A, Oneson R H, Herold D A. Use of cerebrospinal fluid lactic acid concentration in the diagnosis of fungal meningitis. Ann Clin Lab Sci . 1987; 17 429
56 Tsuge I, Makimura K, Natsume J. Successful polymerase chain reaction-based diagnosis of fungal meningitis in a patient with chronic granulomatous disease. Acta Paediatr Jpn . 1998; 40 356
57 Ralph E D, Hussain Z. Chronic meningitis caused by Candida albicans in a liver transplant recipient: usefulness of the polymerase chain reaction for diagnosis and for monitoring treatment. Clin Infect Dis . 1996; 23 191
58 Phanthumchinda K, Sinsawaiwong S, Hemachudha T, Yodnophaklao P. Idiopathic hypertrophic cranial pachymeningitis: an unusual cause of subacute and chronic headache. Headache . 1997; 37 249
59 Nishizaki T, Iwamoto F, Uesugi S, Akimura T, Yamashita K, Ito H. Idiopathic cranial pachymeningoencephalitis focally affecting the parietal dura mater and adjacent brain parenchyma: case report. Neurosurgery . 1997; 40 840
60 Masson C, Henin D, Hauw J J, Rey A, Raverdy P, Masson M. Cranial pachymeningitis of unknown origin: a study of seven cases. Neurology . 1993; 43 1329
61 Hamilton S R, Smith C H, Lessell S. Idiopathic hypertrophic cranial pachymeningitis. J Clin Neuroophthalmol . 1993; 13 127
62 Goyal M, Malik A, Mishra N K, Gaikwad S B. Idiopathic hypertrophic pachymeningitis: spectrum of the disease. Neuroradiology . 1997; 39 619
63 Perfect J R, Casadevall A. Cryptococcus neoformans Washington, DC: ASM Press; 1998 .
64 Mitchell D H, Sorrell T C, Allworth A M. Cryptococcal disease of the CNS in immunocompetent hosts: Influence of cryptococcal variety on clinical manifestations and outcome. Clin Infect Dis . 1995; 20 611
65 Speed B, Dunt D. Clinical and host differences between infections with the two varieties of Cryptococcus neoformans Clin Infect Dis . 1995; 21 28
66 Kovacs J A, Kovacs A A, Polis M. Cryptococcosis in the acquired immunodeficiency syndrome. Ann Intern Med . 1985; 103 533
67 Weink T, Rogler G, Sixt C. Cryptococcosis in AIDS patients: observations concerning CNS involvement. J Neurol . 1989; 236 38
68 Pappas P G, Perfect J R. Cryptococcosis in the non-HIV infected patient [Abstract]. 4th International Conference on Cryptococcus and Cryptococcosis, 1999
69 Baker R D. The primary pulmonary lymph node complex of cryptococcosis. Am J Clin Pathol . 1976; 65 83
70 Merkel G J, Scofield B A. Conditions affecting the adherence of Cryptococcus neoformans to rat glial and lung cells in vitro. J Med Vet Mycol . 1993; 31 55
71 Jimenez-Lucho V, Ginsburg V, Krivan H C. Cryptococcus neoformans, Candida albicans, and other fungi bind specifically to the glycosphingolipid lactosylceramide (Gal-B1-4Glc B1-1 Cer), a possible adhesion receptor for yeasts. Infect Immun . 1990; 58 2085
72 Granger D L, Perfect J R, Durack D T. Virulence of Cryptococcus neoformans: regulation of capsule synthesis by carbon dioxide. J Clin Invest . 1985; 76 508
73 Kwon-Chung K J, Rhodes J C. Encapsulation and melanin formation as indicators of virulence in Cryptococcus neoformans Infect Immun . 1986; 51 218
74 Polacheck I, Platt Y, Aronovitch J. Catecholamines and virulence of Cryptococcus neoformans Infect Immun . 1990; 58 2919
75 Jacobson E S, Emery H S. Catecholamine uptake, melanization, and oxygen toxicity in Cryptococcus neoformans J Bacteriol . 1991; 173 401
76 Jacobson E S, Tinnell S B. Antioxidant function of fungal melanin. J Bacteriol . 1993; 175 7102
77 Chang Y C, Kwon-Chung K J. Complementation of a capsule-deficiency mutation of Cryptococcus neoformans restores its virulence. Mol Cell Biol . 1994; 14 4912
78 Williamson P R. Biochemical and molecular characterization of the diphenol oxidase of Cryptococcus neoformans: identification as a laccase. J Bacteriol . 1994; 176 656
79 Moore T D, Edman J C. The alpha-mating type locus of Cryptococcus neoformans contains a peptide pheromone gene. Mol Cell Biol . 1993; 13 1962
80 Perfect J R, Toffaletti D L, Rude T H. The gene encoding for phosphoribosylaminoimidazole carboxylase (ADE2) is essential for growth of Cryptococcus neoformans in cerebrospinal fluid. Infect Immun . 1993; 61 4446
81 Schimpff S C, Bennett J E. Abnormalities in cell-mediated immunity in patients with Cryptococcus neoformans infection. J Allergy Clin Immunol . 1975; 55 430
82 Horn C A, Washburn R. Anticryptococcal activity of NK cell-enriched peripheral blood lymphocytes from human immunodeficiency virus-infected subjects: responses to interleukin-2, interferon-gamma, and interleukin-12. J Infect Dis . 1995; 172 1023
83 Henderson D K, Bennett J E, Huber M A. Long-lasting specific immunologic unresponsiveness associated with cryptococcal meningitis. J Clin Invest . 1982; 69 1185
84 Hidore M R, Murphy J W. Correlation of natural killer cell activity and clearance of Cryptococcus neoformans from mice after adoptive transfer of splenic nylon wool-nonadherent cells. Infect Immun . 1986; 51 547
85 Lim T S, Murphy J W. Transfer of immunity to cryptococcosis by T-enriched splenic lymphocytes from Cryptococcus neoformans-sensitized mice. Infect Immun . 1980; 30 5
86 Sotomayor C E, Rubinstein H R, Riera C M, Masih D T. Immunosuppression in experimental cryptococco sis: Variation of splenic and thymic populations and expression of class II major histocompatibility complex gene products. Clin Immunol Immunopathol . 1995; 77 19
87 Nassar F, Brummer E, Stevens D A. Macrophage colony-stimulating factor (M-CSF) induction of enhanced anticryptococcal activity in human monocyte-derived macrophages: synergy with fluconazole for killing. Cell Immunol . 1995; 64 113
88 Perfect J R, Hobbs M M, Granger D L, Durack D T. Cerebrospinal fluid macrophage cytotoxicity: in vitro and in vivo correlation. Infect Immun . 1988; 56 849
89 Mody C H, Lipscomb M F, Street N E, Toews G B. Depletion of CD4+ (L3T4+) lymphocytes in vivo impairs murine host defenses to Cryptococcus neoformans J Immunol . 1990; 144 1472
90 Hill J O. CD4+ T cells cause multinucleated giant cells to form around Cryptococcus neoformans and confine the yeast within the primary site of infection in the respiratory tract. J Exp Med . 1992; 175 1685
91 Marquis G, Montplaisir S, Pelletier M. Genetic resistance to murine cryptococcosis: the beige mutation (Chédiak-Higashi syndrome) in mice. Infect Immun . 1985; 47 288
92 Cauley L K, Murphy J W. Response of congenital athymic (nude) and phenotypically normal mice to Cryptococcus neoformans infection. Infect Immun . 1979; 23 644
93 Diamond R D, May J E, Kane M A. The role of the classical and alternative complement pathways in host defense against Cryptococcus neoformans infection. J Immunol . 1974; 112 2260
94 Graybill J R, Hague M, Drutz D L. Passive immunization in murine cryptococcosis. Sabouraudia . 1981; 19 237
95 Louria D B, Kaminski T. Passively-acquired immunity in experimental cryptococcosis. Sabouraudia . 1965; 4 80
96 Diamond R D, Allison A C. Nature of the effector cells responsible for antibody-dependent cell-mediated killing of Cryptococcus neoformans Infect Immun . 1976; 14 716
97 Miller G PG, Kohl S. Antibody-dependent leukocyte killing of Cryptococcus neoformans J Immunol . 1983; 131 1455
98 Diamond R D, Bennett J E. Prognostic factors in cryptococcal meningitis: a study of 111 cases. Ann Intern Med . 1974; 80 176
99 Perfect J R, Lang D R, Durack D T. Influence of agglutinating antibody in experimental cryptococcal meningitis. Br J Exp Pathol . 1981; 62 595
100 Dromer F, Charreire J, Contrepois A, Carbon C, Yeni P. Protection of mice against experimental cryptococcosis by anti-Cryptococcus neoformans monoclonal antibody. Infect Immun . 1987; 55 749
101 Mukherjee J, Pirofski L A, Scharff M D, Casadevall A. Antibody-mediated protection in mice with lethal intracerebral Cryptococcus neoformans infection. Proc Natl Acad Sci U S A . 1993; 90 3636
102 Mukherjee J, Zuckier L S, Scharff M D, Casadevall A. Therapeutic efficacy of monoclonal antibodies to Cryptococcus neoformans glucuronoxylomannan alone and in combination with amphotericin B. Antimicrob Agents Chemother . 1994; 38 580
103 Goodman J S, Kaufman L, Loening M G. Diagnosis of cryptococcal meningitis: detection of cryptococcal antigen. N Engl J Med . 1971; 285 434
104 Kaufman L, Blumer S. Latex-cryptococcal antigen test. Am J Clin Pathol . 1973; 60 285
105 Snow R M, Dismukes W E. Cryptococcal meningitis: diagnostic value of cryptococcal antigen in cerebrospinal fluid. Arch Intern Med . 1975; 135 1155
106 Beeson P B. Cryptococcic meningitis of nearly sixteen years' duration. Arch Intern Med . 1952; 89 797
107 Sarosi G A, Parker J D, Doto I L, Tosh F E. Amphotericin B in cryptococcal meningitis: long-term results of treatment. Ann Intern Med . 1969; 71 1079
108 Bennett J E, Dismukes W, Duma R J. A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptococcal meningitis. N Engl J Med . 1979; 301 126
109 Dismukes W E, Cloud G, Gallis H A. Treatment of cryptococcal meningitis with combination amphotericin B and flucytosine for four as compared with six weeks. N Engl J Med . 1987; 317 334
110 Saag M S, Cloud G A, Graybill J R. A comparison of itraconazole versus fluconazole as maintenance therapy for AIDS-associated cryptococcal meningitis [Abstract]. Clin Infect Dis . 1999; 28 291
111 Stamm A M, Diasio R B, Dismukes W E. Toxicity of amphotericin B plus flucytosine in 194 patients with cryptococcal meningitis. Am J Med . 1987; 83 236
112 Leenders A C, Reiss P, Portegies P. Liposomal amphotericin B (AmBisome) compared with amphotericin B followed by oral fluconazole in the treatment of AIDS-associated cryptococcal meningitis. AIDS . 1997; 11 1463
113 Saag M S, Powderly W G, Cloud G A. Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. N Engl J Med . 1992; 326 83
114 Larsen R A, Leal M AE, Chan L S. Fluconazole compared with amphotericin B plus flucytosine for cryptococcal meningitis in AIDS. Ann Intern Med . 1990; 113 183
115 Galgiani J N. Fluconazole: a new antifungal agent. Ann Intern Med . 1990; 113 177
116 Bozette S A, Larsen R A, Chiu J. A placebo-controlled trial of maintenance therapy with fluconazole after treatment of cryptococcal meningitis in the acquired immunodeficiency syndrome. N Engl J Med . 1991; 324 580
117 Sugar A M, Saunders C. Oral fluconazole as suppressive therapy of disseminated cryptococcosis in patients with acquired immunodeficiency syndrome. Am J Med . 1988; 85 481
118 Stern J J, Hartman B J, Sharkey P. Oral fluconazole therapy for patients with the acquired immunodeficiency syndrome and cryptococcosis: experience with 22 patients. Am J Med . 1988; 85 477
119 Powderly W G, Saag M S, Cloud G A. A controlled trial of fluconazole or amphotericin B to prevent relapse of cryptococcal meningitis in patients with the acquired immunodeficiency syndrome. N Engl J Med . 1992; 326 793
120 Denning D W, Armstrong R W, Lewis B H, Stevens D A. Elevated cerebrospinal fluid pressures in patients with cryptococcal meningitis and acquired immunodeficiency syndrome. Am J Med . 1991; 91 267
121 Tang L M. Ventriculoperitoneal shunt in cryptococcal meningitis with hydrocephalus. Surg Neurol . 1990; 33 314
122 Walsh T J, Schlegel R, Moody M M, Costerton J W, Saloman M. Ventriculoatrial shunt infection due to Cryptococcus neoformans: an ultrastructural and quantitative microbiological study. Neurosurgery . 1986; 18 373
123 Yadav Y R, Perfect J R, Friedman A. Successful treatment of cryptococcal ventriculo-atrial shunt infection with systemic therapy alone. Neurosurgery . 1988; 23 317
124 Flynn P M, Mariana N M, Rivera G K, Hughes W F. Candida tropicalis infections in children with aspergillus leukemia. Leuk Lymphoma . 1993; 10 369
125 Heing E, Djaldetti M, Pinkhas J, De Vries A. Candida tropicalis meningitis in Hodgkin's disease. JAMA . 1967; 199 214
126 Sarma P S, Buraira P, Padhye A A. Candida lusitaniae causing fatal meningitis. Postgrad Med J . 1993; 69 878
127 Leggiadro R J, Collins T. Candida lusitaniae meningitis. Pediatr Infect Dis J . 1988; 7 368
128 Sanchez P J, Cooper B H. Candida lusitaniae: sepsis and meningitis in a neonate. Pediatr Infect Dis J . 1987; 6 785
129 Faix R G. Candida parapsilosis meningitis in a premature infant. Pediatr Infect Dis J . 1983; 2 462
130 Mori T, Ebe T. Analysis of cases of central nervous system fungal infections reported in Japan between January 1979 and June 1989. Intern Med . 1992; 31 174
131 Huttova M, Hartmanova I, Kralinsky K. Candida fungemia in neonates treated with fluconazole: report of forty cases, including eight with meningitis. Pediatr Infect Dis J . 1998; 17 1012
132 Arisoy E S, Arisoy A E, Dunne Jr W M. Clinical significance of fungi isolated from cerebral fluid in children. Pediatr Infect Dis J . 1994; 13 127
133 Olmedo D I, Pallas A CR, Miralles M M, Simon d lHR, Rodriquez O J, Chasco I A. Neonatal meningitis: study of 56 cases. An Esp Pediatr . 1997; 46 189
134 Mukoyama M, Gimple K, Poser C M. Aspergillosis of the central nervous system: report of a brain abscess due to A. fumigatus and review of the literature. Neurology . 1969; 19 967
135 Buch S. Candida meningitis: a growing threat to premature and full-term infants. Pediatr Infect Dis J . 1985; 4 122
136 Oleske J, Minnefor A, Cooper R. Immune deficiency syndrome in children. JAMA . 1983; 249 2345
137 Ludviksson B R, Thoraparensen O, Gudnason T, Halldorsson S. Candida albicans meningitis in a child with myeloperoxidase deficiency. Pediatr Infect Dis J . 1993; 12 162
138 Rodriquez-Arrondo F, Aquirrebengoa K, De Arce A. Candidal meningitis in HIV-infected patients: treatment with fluconazole. Scand J Infect Dis . 1998; 30 417
139 Casado J L, Quereda C, Oliva J. Candidal meningitis in HIV-infected patients: analysis of 14 cases. Clin Infect Dis . 1997; 25 673
140 del Pozo M M, Bermejo F, Molina J A, de la Fuente E C, Martinez-Martin P, Benito-Leon J. Chronic neutrophilic meningitis caused by Candida albicans Neurologia . 1998; 13 362
141 Voice R A, Bradley S F, Sangeorzan J A, Kauffman C A. Chronic candidal meningitis: an uncommon manifestation of candidiasis. Clin Infect Dis . 1994; 19 60
142 Nguyen M H, Yu V L. Meningitis caused by Candida species: an emerging problem in neurosurgical patients. Clin Infect Dis . 1995; 21 323
143 Sanchez-Portocarrero J, Martin-Rabadan P, Saldana C J, Perez-Cecilia E. Candida cerebrospinal fluid shunt infection: report of two new cases and review of the literature. Diagn Microbiol Infect Dis . 1994; 20 33
144 Poon W S, Ng S, Wai S. CSF antibiotic prophylaxis for neurosurgical patients with ventriculostomy: a randomized study. Acta Neurochir Suppl . 1998; 71 146
145 Kaji M, Shoji H, Oizumi K. Intractable meningitis and intracranial abscess following sinusitis due to Candida species. Kurume Med J . 1998; 45 279
146 Kupsky R R, Kupsky W J, Haas J E. Arteritis and fatal subarachnoid hemorrhage complicating occult Candida meningitis: unusual presentation in pediatric acquired immunodeficiency syndrome. Arch Pathol Lab Med . 1998; 122 1030
147 Scheld W M, Lee D, Bernard E M. CSF arabinitol in experimental Candida albicans meningitis. ICAAC Abstract . 1984; 1168
148 Geers T A, Gordon S M. Clinical significance of Candida species isolated from cerebrospinal fluid following neurosurgery. Clin Infect Dis . 1999; 28 1139
149 Smego R A, Perfect J R, Durack D T. Combined therapy with amphotericin B and 5-fluorocytosine for Candida meningitis. Rev Infect Dis . 1984; 6 791
150 Jafari H S, Saez-Llorens X, Severein C. Effects of antifungal therapy on inflammation, sterilization, and histology in experimental Candida albicans meningitis. Antimicrob Agents Chemother . 1994; 38 83
151 Jarlov J O, Born P, Bruun B. Candida albicans meningitis in a 27 weeks premature infant treated with liposomal amphotericin-B. Scand J Infect Dis . 1995; 27 419
152 Houmeau L, Monfort-Gouraud M, Boccara J F, Badoual J. Candida meningitis, in a premature infant, treated with liposomal amphotericin B and flucytosine. Arch Fr Pediatr . 1993; 50 227
153 Lee B E, Cheung P Y, Robinson J L, Evanochko C, Robertson C M. Comparative study of mortality and morbidity in premature infants (birth weight <1.250 g) with candidemia or candidal meningitis. Clin Infect Dis . 1998; 27 559
154 Murai H, Kira J, Kobayashi T, Goto I, Inoue H, Hasuo K. Hypertrophic cranial pachymeningitis due to Aspergillus flavus Clin Neurol Neurosurg . 1992; 94 247
155 Gordon M A, Holzman R S, Senter H, Lapa E W, Kupersmith M J. Aspergillus orzyme meningitis. JAMA . 1976; 235 2122
156 Morris A, Schell W A, McDonagh D, Chafee S, Perfect J R. Fonsecaea pedrosoi pneumonia and Emericella nidulans cerebral abscesses in a bone marrow transplant patient. Clin Infect Dis . 1995; 21 1346
157 Jamjoom A B, al-Hedaithy S A, Jamjoom Z A. Intracranial mycotic infections in neurosurgical practice. Acta Neurochir . 1995; 137 78
158 Beal M F, O'Carroll C P, Kleinman G M, Grossman R I. Aspergillosis of the nervous system. Neurology . 1982; 32 473
159 Torre-Cisneros J, Lopez O L, Kusne S. CNS aspergillosis in organ transplantation: a clinicopathological study. J Neurol Neurosurg Psychiatry . 1993; 56 188
160 Morrow R, Wong B, Finkelstein W E, Sternberg S S, Armstrong D. Aspergillosis of the cerebral ventricles in a heroin abuser: case report and review of the literature. Arch Intern Med . 1983; 143 161
161 Kaufman D M, Thal L J, Farmer P M. Central nervous system aspergillosis in two young adults. Neurology . 1976; 26 484
162 Feely M, Steinberg M. Aspergillus infection complicating trassphenoidal yttrium-90 pituitary implant: report of two cases. J Neurosurg . 1977; 46 530
163 Radhakrishnan V V, Saraswathy A, Rout D, Mohan P K. Mycotic aneurysms of the intracranial vessels. Indian J Med Res . 1994; 100 228
164 Mikolich D J, Kinsella L J, Skowron G, Friedman J, Sugar A M. Aspergillus meningitis in an immunocompetent adult successfully treated with itraconazole. Clin Infect Dis . 1996; 23 1318
165 Haran R P, Chandy M J. Intracranial aspergillus granuloma. Br J Neurosurg . 1993; 7 383
166 Breneman E, Colford Jr J M. Aspergillosis of the CNS presenting as aseptic meningitis. Clin Infect Dis. 1992; 15 737
167 Carrazana E J, Rossitch Jr E, Morris J. Isolated central nervous system aspergillosis in the acquired immunodeficiency syndrome. Clin Neurol Neurosurg . 1991; 93 227
168 Larranaga J, Fandino J, Gomez-Bueno J, Rodriguez D, Gonzalez-Carrero J, Botana C. Aspergillosis of the sphenoid sinus simulating a pituitary tumor. Neuroradiology . 1989; 31 362
169 Bryan C S, DiSalvo A F, Huffman L J, Kaplan W, Kaufman L. Communicating hydrocephalus caused by Aspergillus flavus South Med J . 1989; 73 1641
170 Verweij P E, Brinkman K, Kremer H PH, Kullberg B J, Meis J F. Aspergillus meningitis: diagnosis by non-culture-based microbiological methods and management. J Clin Microbiol . 1999; 37 1186
171 Ray P, Chakrabarti A, Jatana M, Sharma B S, Pathak A. Western blot analysis of cerebrospinal fluid for detection of Aspergillus antigens. Mycopathologia . 1995; 131 103
172 Bronnimann D A, Adam R D, Galgiani J N. Coccidioidomycosis in the acquired immunodeficiency syndrome. Ann Intern Med . 1987; 106 372
173 Young R F, Gade G, Grinell V. Surgical treatment for fungal infections in the central nervous system. JNeurosurg . 1985; 63 371
174 Mischel P S, Vinters H V. Coccidioidomycosis of the central nervous system: neuropathological and vasculopathic manifestations and clinical correlates. Clin Infect Dis . 1995; 20 400
175 Banuelos A F, Williams P L, Johnson R H. Central nervous system abscesses due to Coccidioides species. Clin Infect Dis . 1996; 22 240
176 Mendel E, Milefchik E N, Amadi J, Gruen P. Coccidioidomycosis brain abscess: case report. J Neurosurg . 1994; 81 614
177 Winston D J, Kurtz T O, Fleischmann J, Morgan D, Batzdorf U, Stern W E. Successful treatment of spinal arachnoiditis due to coccidioidomycosis: case report. J Neurosurg . 1983; 59 328
178 Anonymous. Vasculitic and encephalitic complications associated with Coccidioides immitis infection of the central nervous system in humans: report of 10 cases and review. Clin Infect Dis . 1992; 14 673
179 de Carvalho C A, Allen J N, Zafranis A, Yates A J. Coccidioidal meningitis complicated by cerebral arteritis and infarction. Hum Pathol . 1980; 11 293
180 Arsura E L, Kilgore W B, Caldwell J W, Freeman J C, Einstein H E, Johnson R H. Association between facial cutaneous coccidioidomycosis and meningitis. West J Med . 1998; 169 13
181 Galgiani J N, Peng T, Lewis M L, Cloud G A, Pappagianis D. Cerebrospinal fluid antibodies detected by ELISA against a 33-kDa antigen from spherules of Coccidioides immitis in patients with coccidioidal meningitis. The National Institute of Allergy and Infectious Diseases Mycoses Study Group. JInfect Dis . 1996; 173 499
182 Ragland A S, Arusa E, Ismail Y, Johnson R. Eosinophilic pleocytosis in coccidioidal meningitis: frequency and significance. Am J Med . 1993; 195 254
183 Morwood D T, Nichter L S, Wong V. An unusual complication of an open-head injury: coccidioidal meningitis. Ann Plast Surg . 1989; 23 437
184 Peterson C M, Johnson S L, Kelly J V, Kelly P C. Coccidioidal meningitis and pregnancy: a case report. Obstet Gynecol . 1989; 73 835
185 Dewsnup D H, Galgiani J N, Graybill J R. Is it ever safe to stop azole therapy for Coccidioides immitis meningitis?. Ann Intern Med . 1996; 124 305
186 Duncan R A, vonReyn C F, Alliegro G M, Toossi Z, Sugar A M, Levitz S M. Idiopathic CD4+ T-lymphocytopenia: four patients with opportunistic infections and no evidence of HIV infection. N Engl J Med . 1993; 328 393
187 Weidenheim K M, Nelson S J, Kure K, Harris C, Biempica L, Dickson D W. Unusual patterns of Histoplasma capsulatum meningitis and progressive multifocal leukoencephalopathy in a patient with the acquired immunodeficiency virus. Hum Pathol . 1992; 23 581
188 Anaissie E, Fainstein V, Samo T, Bodey G P, Sarosi G A. Central nervous system histoplasmosis: an unappreciated complication of the acquired immunodeficiency syndrome. Am J Med . 1988; 84 215
189 Wright S H, Czaja A J, Katz R S, Soloway R D. Systemic mycosis complicating high dose corticosteroid treatment of chronic active liver disease. Am J Gastroenterol . 1980; 74 428
190 Wheat L J, Slama T G, Zeckel M L. Histoplasmosis in the acquired immune deficiency syndrome. Am J Med . 1985; 78 203
191 Wheat J, French M, Batteiger B, Kohler R. Cerebrospinal fluid Histoplasma antibodies in central nervous system histoplasmosis. Arch Intern Med . 1985; 145 1237
192 Wheat L J, Kohler R B, Tewari R P, Garten M, French M L. Significance of histoplasma antigen in the cerebrospinal fluid of patients with meningitis. Arch Intern Med . 1989; 149 302
193 Kravitz G R, Davies S F, Eckman M R, Sarosi G A. Chronic blastomycotic meningitis. Am J Med . 1981; 71 501
194 Harley W B, Lomis M, Haas D W. Marked polymorphonuclear pleocytosis due to blastomycotic meningitis: a case report and review. Clin Infect Dis . 1994; 18 816
195 Mangham D, Gerding D N, Peterson L R, Sarosi G A. Fungal meningitis manifesting in hydrocephalus. Arch Intern Med . 1983; 143 728
196 Penn C C, Goldstein E, Bartholomew W R. Sporothrix schenckii meningitis in a patient with AIDS. Clin Infect Dis . 1992; 15 741
197 Scott E N, Kaufman L, Brown A C, Muchmore H G. Serologic studies in the diagnosis and management of meningitis due to Sporothrix schenckii N Engl J Med . 1987; 317 935
198 Supparatpinyo K, Khamwan C, Baosoung V, Nelson K E. Disseminated Penicillium marneffei in South-east. Lancet . 1994; 344 110
199 Agamanolis D P, Kalwinsky D K, Krill Jr C E, Dasu S, Halasa B, Galloway P G. Fusarium meningoencephalitis in a child with acute leukemia. Neuropediatrics . 1991; 22 110
200 Steinberg G K, Britt R H, Enzmann D R. Fusarium brain abscess: case report. J Neurosurg . 1983; 58 598
201 Fincher R M, Fisher J F, Lovell R D, Newman C L, Espinel-Ingroff A, Shadomy H J. Infection due to the fungus Acremonium (Cephalosporium) Medicine (Baltimore) . 1991; 70 398
202 Dixon D M, Walsh T J. Infections due to Xylohypha bantiana (Cladosporium trichoides) Rev Infect Dis . 1989; 11 515
203 Bennett J E, Bonner H, Jennings A E, Lopez R I. Chronic meningitis caused by Cladosporium trichoides Am J Clin Pathol . 1973; 59 398
204 Kershaw P, Freeman R, Templeton D. Pseudallescheria boydii infection of the central nervous system. Arch Neurol . 1990; 47 468
205 Berenguer J, Diaz-Mediavilla J, Urra D, Munoz P. Central nervous system infection caused by Pseudoallescheria boydii: case report and review. Rev Infect Dis . 1989; 11 890
206 Jones P G, Gilman R M, Medeiros A A, Dyckman J. Focal intracranial mucomycosis presenting as chronic meningitis. JAMA . 1981; 246 2063
207 Meyers B R, Wormser G, Hirschman S Z, Blitzer A. Rhinocerebral mucormycosis premortem diagnosis and therapy. Arch Intern Med . 1979; 139 557
208 McLean F M, Ginsberg L E, Stanton C A. Perineural spread of rhinocerebral mucormycosis. AJNR . 1996; 17 114
209 Windus D W, Stokes T J, Julian B A, Fenves A Z. Fatal rhizopus infections in hemodialysis patients receiving deferoxamine. Ann Intern Med . 1987; 107 678