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Fungal infections of the central nervous system

Comparative analysis of risk factors and clinical signs in 57 patients

From the Department of Pathology (Dr. Walsh), The Johns Hopkins Hospital, and the Department of Neurology (Drs. Hier and Caplan), Michael Reese Hospital and Medical Center.

Risk factors and clinical manifestations of fungal infections of the CNS were analyzed in 57 autopsied patients. Aspergillosis occurred in 16, candidiasis in 27, and cryptococcosis in 14. Nine of 31 variables studied showed significant difference (p < 0.01). Cryptococcosis was community-acquired in 93%; whereas, aspergillosis and candidiasis were nosocomial in more than 95%. Focal neurologic deficits developed in 50% with CNS aspergillosis, but in only 4% with candidiasis. Meningeal signs occurred in 86% with CNS cryptococcosis, but in only 6% with aspergillosis and 7% with candidiasis. Discriminant analysis demonstrated that CNS aspergillosis was most frequently a nosocomial infection with focal neurologic deficits, pulmonary infiltrates, and hypercortisolemia. Cryptococcosis was generally a non-nosocomial infection with meningeal signs presenting in an ambulatory population. CNS candidiasis was a clinically occult nosocomial fungal infection with generally no deficits or meningismus, occurring most frequently in the neonate, the elderly, and surgical patients. The discriminant functions, which correctly classified 91% of these CNS fungal infections, may be applicable in clinical diagnosis.

Address correspondence and reprint requests to Dr. Walsh, University of Maryland Cancer Center, 22 South Greene Street, Baltimore, MD 21201.

Dr. Walsh is a recipient of the Janssen Medical Mycology Fellowship Award of the National Foundation for Infectious Diseases.

Accepted for publication February 13, 1985

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