Semin Neurol 2000; Volume 20(Number 03): 307-322
DOI: 10.1055/s-2000-9394
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Fungal Meningitis

Magnús Gottfredsson1,2 , 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
Further Information

Publication History

Publication Date:
31 December 2000 (online)

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.

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
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