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Aspergillosis

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Fungal Infections of the Central Nervous System

Abstract

Central nervous system (CNS) aspergillosis is rare and constitutes 10–20% of invasive aspergillosis. CNS aspergillosis is reported in immunosuppressed hosts with dissemination from the lung or heart by hematogenous spread, usually by Aspergillus fumigatus, whereas it is reported in immunocompetent hosts by contiguous spread from sinus, ear, or orbit, usually by A. flavus. Environmental factors and virulence factors of the pathogen are implicated in the pathogenesis. Neutropenia and administration of corticosteroids are important risk factors in immunosuppressed hosts, whereas hot and humid climate with constant exposure to high inoculums of pathogen predisposes to infection in immunocompetent hosts. Though CNS is protected by blood-brain barrier and blood-cerebrospinal fluid barrier and innate immunity, the pathogen evades the immune attack by its virulence factors and secretes proteases and toxins to facilitate invasion and growth in the host. The pathology depends on the immune status of the host, route of spread, and virulence of the pathogen. The pathology in disseminated disease is infarction with or without hemorrhage and single/multiple abscesses, whereas it is granuloma with extensive fibrosis in sinocranial aspergillosis. Meningitis and mycotic aneurysm are uncommon. Early diagnosis is important for timely and appropriate treatment. Histopathology and culture have less sensitivity for diagnosis but are still recommended where tissue can be obtained, till molecular tests are widely available. Galactomannan test with validated polymerase chain reaction is useful in disseminated disease, but still not validated for routine use. This review focuses on the host pathogen interactions, pathology, and diagnosis of CNS aspergillosis.

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Abbreviations

BAL:

Broncoalveolar lavage

BBB:

Blood-brain barrier

BG:

Β-D-glucan

CGD:

Chronic granulomatous disease

CNS:

Central nervous system

CR:

Complement receptor

CSF:

Cerebrospinal fluid

EM:

Extracellular matrix

FFPE:

Formalin-fixed parafin embedded

GAG:

Galactosaminogalactan

GM:

Galactomannan

GMS:

Gomori’s methenamine silver

H&E:

Hematoxylin and eosin

HSCT:

Hematopoietic stem cell transplant

IA:

Invasive aspergillosis

ICSOL:

Intracranial space occupying lesion

IHC:

Immunohistochemistry

PAMP:

Pathogen-associated molecular pattern

PCR:

Polymerase chain reaction

PAS:

Periodic acid-Schiff

PTX:

Pentraxin

ROS:

Reactive oxygen species

TLRs:

Toll-like receptors

TNF:

Tumor necrosis factor

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Acknowledgment

The author, who was former Dean and Senior Professor of Pathology at Nizam’s Institute of Medical Sciences, Hyderabad, gratefully acknowledges all the colleagues, students, and technical staff for their contribution.

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Authors and Affiliations

  1. Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, Telangana, India

    Sundaram Challa

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  1. Sundaram Challa
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Editors and Affiliations

  1. Department of Neurosurgery, Aydın Adnan Menderes University, School of Medicine, Aydın, Turkey

    Mehmet Turgut

  2. Department of Pathology, Basavatarakam Indo-American Hospital & Research Institute, Hyderabad, Telangana, India

    Sundaram Challa

  3. Department of Neurosurgery, Avicenne Military Hospital, Mohammed V University in Rabat, Marrakech, Morocco

    Ali Akhaddar

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Challa, S. (2019). Aspergillosis. In: Turgut, M., Challa, S., Akhaddar, A. (eds) Fungal Infections of the Central Nervous System. Springer, Cham. https://doi.org/10.1007/978-3-030-06088-6_8

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  • DOI: https://doi.org/10.1007/978-3-030-06088-6_8

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