Spectrum of central nervous system mycoses and antifungal susceptibility: a two-year retrospective analysis from a tertiary care hospital in India
-
Sukanya Sudhaharan
,
Umabala Pamidimukkala
,
Shivani Bojja
,
Nikhil Gandi
,
Vamsi Krishna Yerramneni
,
Sireesha Yareeda
Abstract
Background and Objectives: The frequency of central nervous system (CNS) fungal infections is rising, leading to increased mortality. These infections pose diagnostic challenges, and therapy depends on the specific fungal pathogen identified. Only a few studies from India have examined the spectrum of fungal pathogens causing CNS infections. The objective of this study was to analyze the clinical and microbiological diversity of fungal pathogens responsible for CNS infections.
Materials and Methods: This was a retrospective study conducted at a tertiary care center in India from January 2023 to December 2024. The study included patients in whom fungi were isolated from cerebrospinal fluid, brain abscess pus, and paraspinal abscesses.
Results: Nine fungal pathogens were identified during the study period. Three isolates were yeasts and six were molds. Brain abscess was the predominant clinical presentation. The yeast isolates included Cryptococcus neoformans (n = 1) in meningitis and Candida tropicalis (n = 1) and Candida parapsilosis (n = 1) in VP shunt infections. The molds isolated from brain abscesses included Cladophialophora bantiana (n = 1), Rhizopus arrhizus (n = 1), Aspergillus flavus (n = 2), Scedosporium apiospermum (n = 1), and Chaetomium lucknowensis (n = 1). Mortality was observed in 4 of 9 cases (44.4%).
Conclusion: In the present study, nine fungal pathogens were isolated over a two‑year period from varied clinical presentations. This highlights the rarity of the condition, which should not be overlooked.
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26. Ullmann AJ, Aguado JM, Arikan-Akdagli S, Denning DW, Groll AH, Lagrou K, et al. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 2018; 24(Suppl 1): e1-e38.
27. Dalmazzo M, Padrini M, Camerlo S, Rosati G, Busana TT, Nicoli P, et al. Scedosporium Brain Abscess: A Rare and Fatal Drawback of Bruton Tyrosine Kinase Inhibitor Therapy. J Hematol 2024; 13: 224-228.
28. Sharma A, Singh D. Scedosporium apiospermum causing brain abscess in a renal allograft recipient. Saudi J Kidney Dis Transpl 2015; 26: 1253-1256.
29. Torres-Sánchez MJ, Hernández-García E, Gómez-Sánchez J, Palomares-Bayo M, Peña-Ortega M, Galindo-Sacristán P, et al. Severe Scedosporium apiospermum Infection in a Recent Renal Transplant Recipient: Case Report. Transplant Proc 2018; 50: 683-684.
30. Signore SC, Dohm CP, Schütze G, Bähr M, Kermer P. Scedosporium apiospermum brain abscesses in a patient after near-drowning - a case report with 10-year follow-up and a review of the literature. Med Mycol Case Rep 2017; 17: 17-19.
31. Abbott SP, Sigler L, McAleer R, McGough DA, Rinaldi MG, Mizell G. Fatal cerebral mycoses caused by the ascomycete Chaetomium strumarium. J Clin Microbiol 1995; 33: 2692-2698.
32. Anandi V, John TJ, Walter A, Shastry JC, Lalitha MK, Padhye AA, et al. Cerebral phaeohyphomycosis caused by Chaetomium globosum in a renal transplant recipient. J Clin Microbiol 1989; 27: 2226-2229.
33. Gade N, Nag S, Prathipati KK, Mishra M, Shete V. Chaetomium globosum: Spotting a scarce saprophyte in bacterial-fungal co-infection of the sinuses in a post-COVID-19 patient. Med Mycol Case Rep 2023; 43: 100618.
34. Ashley ED. Antifungal Drugs: Special Problems Treating Central Nervous System Infections. J Fungi (Basel) 2019; 5: 97.
2. Nathan CL, Emmert BE, Nelson E, Berger JR. CNS fungal infections: A review. J Neurol Sci 2021; 422: 117325.
3. Lino R, Guimarães AR, Sousa E, Azevedo M, Santos L. Emerging Fungal Infections of the Central Nervous System in the Past Decade: A Literature Review. Infect Dis Rep 2024; 16: 952-976.
4. Tian YR, Chen XY, Wang JX, Guan M. Pathogenic spectrum and laboratory indicators of fungal infections in the central nervous system. Zhonghua Yu Fang Yi Xue Za Zhi 2022; 56: 250-255.
5. Masouris I, Klein M, Schichor C, Stemmler J, Koedel U, Pfister HW. Clinical, diagnostic, and therapeutic challenges in CNS fungal infections: a single-center retrospective data analysis. J Neurol 2025; 272: 214.
6. P K, Raj P, Jabeen S, Bn N, Hb V, Kvl NR, et al. Clinicomycological overview of brain abscess in a tertiary care center: A 38 year retrospection: Fungal brain abscess. J Mycol Med 2021; 31: 101156.
7. Chakrabarti A, Kaur H, Rudramurthy SM, Appannanavar SB, Patel A, Mukherjee KK, et al. Brain abscess due to Cladophialophora bantiana: a review of 124 cases. Med Mycol 2016; 54: 111-119.
8. Clinical and Laboratory Standards Institute. Performance standards for antifungal susceptibility testing of yeasts. 3rd ed. CLSI supplement M27/M44S. Wayne, PA: CLSI; 2022.
9. Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi. 3rd ed. CLSI document M38. Wayne, PA: CLSI; 2017.
10. Clinical and Laboratory Standards Institute. Epidemiological cutoff values for antifungal susceptibility testing. 4th ed. CLSI supplement M57S. Wayne, PA: CLSI; 2022.
11. Kaur H, Rudramurthy SM, Kanaujia R, Ahmad H, Salunke P, Bansal D, et al. Invasive mould infections of the central nervous system in the Indian population: a cohort study (2004-2025). Lancet Reg Health Southeast Asia 2026; 46: 100736.
12. Maschmeyer G, Patterson TF. New immunosuppressive agents and risk for invasive fungal infections. Curr Infect Dis Rep 2009;11:435-438.
13. McHale TC, Boulware DR, Kasibante J, Ssebambulidde K, Skipper CP, Abassi M. Diagnosis and management of cryptococcal meningitis in HIV-infected adults. Clin Microbiol Rev 2023; 36(4): e0015622.
14. Qureshi ZA, Ghazanfar H, Altaf F, Ghazanfar A, Hasan KZ, Kandhi S, et al. Cryptococcosis and Cryptococcal Meningitis: A Narrative Review and the Up-to-Date Management Approach. Cureus 2024; 16: e55498.
15. Abassi M, Boulware DR, Rhein J. Cryptococcal Meningitis: Diagnosis and Management Update. Curr Trop Med Rep 2015; 2: 90-99.
16. Baradkar VP, Mathur M, Sonavane A, Kumar S. Candidal infections of ventriculoperitoneal shunts. J Pediatr Neurosci 2009; 4: 73-75.
17. Chiou CC, Wong TT, Lin HH, Hwang B, Tang RB, Wu KG, et al. Fungal infection of ventriculoperitoneal shunts in children. Clin Infect Dis 1994; 19:1049-1053.
18. Fadel H, Moon SJ, Klinger NV, Chamiraju P, Eltahawy HA, Moisi MD, et al. Candida parapsilosis Infection of Ventriculoperitoneal Shunt in Adult: Case Report and Literature Review. World Neurosurg 2018; 119: 290-293.
19. Bagheri F, Cervellione KL, Maruf M, Marino W, Santucci T Jr. Candida parapsilosis meningitis associated with shunt infection in an adult male. Clin Neurol Neurosurg 2010; 112: 248-251.
20. Baddley JW, Salzman D, Pappas PG. Fungal brain abscess in transplant recipients: epidemiologic, microbiologic, and clinical features. Clin Transplant 2002; 16: 419-424.
21. Chamdine O, Gaur AH, Broniscer A. Effective treatment of cerebral mucormycosis associated with brain surgery. Pediatr Infect Dis J 2015; 34: 542-543.
22. Doub JB, Greenfield A, Bailey J, Wessell AP, Olexa J, Sansur CA. A unique case of Rhizopus oryzae brain abscess treated with intracavitary amphotericin. Br J Neurosurg 2023; 37: 1281-1284.
23. Siddiqui AA, Shah AA, Bashir SH. Craniocerebral aspergillosis of sinonasal origin in immunocompetent patients: Clinical spectrum and outcome in 25 cases. Neurosurgery 2004; 55: 602-611.
24. Miceli MH. Central Nervous System Infections Due to Aspergillus and Other Hyaline Molds. J Fungi (Basel) 2019; 5: 79.
25. Sagar T, Sheoran L, Prajapati A, Khuraijam B, Jana PP, Pandey PN, et al. Aspergillus fumigatus cerebral abscess following hemodialysis: A case report. Curr Med Mycol 2022; 8: 32-36.
26. Ullmann AJ, Aguado JM, Arikan-Akdagli S, Denning DW, Groll AH, Lagrou K, et al. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 2018; 24(Suppl 1): e1-e38.
27. Dalmazzo M, Padrini M, Camerlo S, Rosati G, Busana TT, Nicoli P, et al. Scedosporium Brain Abscess: A Rare and Fatal Drawback of Bruton Tyrosine Kinase Inhibitor Therapy. J Hematol 2024; 13: 224-228.
28. Sharma A, Singh D. Scedosporium apiospermum causing brain abscess in a renal allograft recipient. Saudi J Kidney Dis Transpl 2015; 26: 1253-1256.
29. Torres-Sánchez MJ, Hernández-García E, Gómez-Sánchez J, Palomares-Bayo M, Peña-Ortega M, Galindo-Sacristán P, et al. Severe Scedosporium apiospermum Infection in a Recent Renal Transplant Recipient: Case Report. Transplant Proc 2018; 50: 683-684.
30. Signore SC, Dohm CP, Schütze G, Bähr M, Kermer P. Scedosporium apiospermum brain abscesses in a patient after near-drowning - a case report with 10-year follow-up and a review of the literature. Med Mycol Case Rep 2017; 17: 17-19.
31. Abbott SP, Sigler L, McAleer R, McGough DA, Rinaldi MG, Mizell G. Fatal cerebral mycoses caused by the ascomycete Chaetomium strumarium. J Clin Microbiol 1995; 33: 2692-2698.
32. Anandi V, John TJ, Walter A, Shastry JC, Lalitha MK, Padhye AA, et al. Cerebral phaeohyphomycosis caused by Chaetomium globosum in a renal transplant recipient. J Clin Microbiol 1989; 27: 2226-2229.
33. Gade N, Nag S, Prathipati KK, Mishra M, Shete V. Chaetomium globosum: Spotting a scarce saprophyte in bacterial-fungal co-infection of the sinuses in a post-COVID-19 patient. Med Mycol Case Rep 2023; 43: 100618.
34. Ashley ED. Antifungal Drugs: Special Problems Treating Central Nervous System Infections. J Fungi (Basel) 2019; 5: 97.
| Files | ||
| Issue | Vol 18 No 3 (2026) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v18i3.21668 | |
| Keywords | ||
| Brain abscesses Meningitis Ventriculoperitoneal shunts Cladophialophora bantiana Scedosporium apiospermum Chaetomium lucknowensis | ||
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How to Cite
1.
Sudhaharan S, Pamidimukkala U, Bojja S, Gandi N, Yerramneni V, Yareeda S. Spectrum of central nervous system mycoses and antifungal susceptibility: a two-year retrospective analysis from a tertiary care hospital in India. Iran J Microbiol. 2026;18(3):413-421.
