CNS Infections pp 119-137 | Cite as

Fungal Infection of the CNS

  • Mansa Amul Munshi
  • Antonella Rella
  • Maurizio Del PoetaEmail author


Fungal infections in the central nervous system have been known to lead to significant morbidity and mortality. Most of these infections are chronic and develop in patients with altered immune response. The most common predisposing factors for fungal CNS infections are HIV, organ transplant, tumors, prolonged antimicrobial therapy, chemotherapy, and long-term use of ventilators and catheters. The most common fungal pathogens are Cryptococcus spp., Candida albicans, Aspergillus spp., Histoplasma capsulatum, Coccidioides spp., and Zygomycetes. Occasionally there are serious outbreaks of rare fungal infections that affect also immunocompetent subjects, bringing to focus the enormity of unknown fungi that pose a threat to humans. The diagnosis is often difficult and the treatment options are limited. Hence, the prognosis of these infections is poor with high morbidity and high mortality. This chapter will discuss the most common fungal infections of the CNS and their challenges.


Fungal infection Central nervous system Meningitis Cryptococcus neoformans Cerebrospinal fluid Amphotericin B Fluconazole 



Amphotericin B lipid complex


Acquired immunodeficiency syndrome


Amphotericin B


Amphotericin B deoxycholate


Central nervous system


Cerebrospinal fluid


Computerized tomography scan

GMS stain

Gomori methenamine silver stain


Human immunodeficiency virus


Lipid formulations of amphotericin B


Matrix-assisted laser desorption ionization mass spectrometry-time of flight


Nuclear magnetic resonance

PAP stain

Papanicolaou stain

PAS stain

Periodic acid schiff stain


Polymerase chain reaction



This work was supported by National Institute of Health (NIH) awards AI56168, AI71142, AI87541, and AI100631 to MDP. Maurizio Del Poeta is a Burroughs Welcome New Investigator in the Pathogenesis of Infectious Diseases. The authors have no conflicts of interest that are directly relevant to the content of this review.


  1. 1.
    Raman Sharma R. Fungal infections of the nervous system: current perspective and controversies in management. Int J Surg. 2010;8(8):591–601.PubMedCrossRefGoogle Scholar
  2. 2.
    Sundaram C, et al. Pathology and diagnosis of central nervous system infections. Patholog Res Int. 2011;878263.Google Scholar
  3. 3.
    Park BJ, et al. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009;23(4):525–30.PubMedCrossRefGoogle Scholar
  4. 4.
    Knoke M, Schwesinger G. One hundred years ago: the history of cryptococcosis in Greifswald. Medical mycology in the nineteenth century. Mycoses. 1994;37(7–8):229–33.PubMedGoogle Scholar
  5. 5.
    Minari RHA, Avery RK, Longworth DL, DeCamp M, Bertin M, Schilz R, Smedira N, Haug MT, Mehta A, Gordon SM. The incidence of invasive aspergillosis among solid organ transplant recipients and implications for prophylaxis in lung transplants. Transpl Infect Dis. 2002;4:195–202.Google Scholar
  6. 6.
    Schaenman JM, Austin JM, Baron EJ, Gamberg P, Miller J, Oyer PE, Robbins RC, Montoya JG. Trends in invasive disease due to Candida species following heart and lung transplantation. Transpl Infect Dis. 2009;11(2):112–21.Google Scholar
  7. 7.
    Husain S, Wagener MM, Singh N. Cryptococcus neoformans infection in organ transplant recipients: variables influencing clinical characteristics and outcome. Emerg Infect Dis. 2001;7(3):375–81.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Silveira FP, Husain S. Fungal infections in solid organ transplantation. Med Mycol. 2007;45(4):305–20.PubMedCrossRefGoogle Scholar
  9. 9.
    Pappas PG, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis. 2010;50(8):1101–11.PubMedCrossRefGoogle Scholar
  10. 10.
    Pappas PG, Alexander B, Andes D, Hadley S, Patterson T, Walker R, Morrison V, Perl T, Wannemuehler K, Chiller T. Prospective surveillance of invasive fungal infections (IfIs) among organ transplant recipients (OTRs) in the U.S. 2001–2006. 47th interscience conference on Antimicrobial Agents and Chemotherapy; Chicago; 17–20 Sept 2007.Google Scholar
  11. 11.
    Singh N, et al. Cryptococcus neoformans in organ transplant recipients: impact of calcineurin-inhibitor agents on mortality. J Infect Dis. 2007;195(5):756–64.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Silveira FP, et al. Cryptococcosis in liver and kidney transplant recipients receiving anti-thymocyte globulin or alemtuzumab. Transpl Infect Dis. 2007;9(1):22–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Singh N, Paterson DL. Aspergillus infections in transplant recipients. Clin Microbiol Rev. 2005;18(1):44–69.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Vilchez RA, Fung J, Kusne S. Cryptococcosis in organ transplant recipients: an overview. Am J Transplant. 2002;2(7):575–80.PubMedCrossRefGoogle Scholar
  15. 15.
    Husain S, et al. Infections due to Scedosporium apiospermum and Scedosporium prolificans in transplant recipients: clinical characteristics and impact of antifungal agent therapy on outcome. Clin Infect Dis. 2005;40(1):89–99.PubMedCrossRefGoogle Scholar
  16. 16.
    Singh N, et al. Zygomycosis in solid organ transplant recipients: a prospective, matched case–control study to assess risks for disease and outcome. J Infect Dis. 2009;200(6):1002–11.PubMedCrossRefGoogle Scholar
  17. 17.
    Nina Singh FYC, Gayowski T, Marino IR. Infections due to dematiaceous fungi in organ transplant recipients: case report and review. Clin Infect Dis. 1997;24(3):369–74.CrossRefGoogle Scholar
  18. 18.
    Husain S, et al. Opportunistic mycelial fungal infections in organ transplant recipients: emerging importance of non-Aspergillus mycelial fungi. Clin Infect Dis. 2003;37(2):221–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Sampathkumar P, Paya CV. Fusarium infection after solid-organ transplantation. Clin Infect Dis. 2001;32(8):1237–40.PubMedCrossRefGoogle Scholar
  20. 20.
    Kulberg B-J. Fungal infections of the central nervous system. Advanced studies in medicine 2003;(1A):S1–S11.Google Scholar
  21. 21.
    Murthy JM. Fungal infections of the central nervous system: the clinical syndromes. Neurol India. 2007;55(3):221–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Posteraro B, et al. MALDI-TOF mass spectrometry in the clinical mycology laboratory: identification of fungi and beyond. Expert Rev Proteomics. 2013;10(2):151–64.PubMedCrossRefGoogle Scholar
  23. 23.
    Davis JA, Costello DJ, Venna N. Laboratory investigation of fungal infections of the central nervous system. Neurol India. 2007;55(3):233–40.PubMedCrossRefGoogle Scholar
  24. 24.
    Thomson Jr RB, Bertram H. Laboratory diagnosis of central nervous system infections. Infect Dis Clin North Am. 2001;15(4):1047–71.PubMedCrossRefGoogle Scholar
  25. 25.
    Bader O. MALDI-TOF-MS-based species identification and typing approaches in medical mycology. Proteomics. 2013;13(5):788–99.PubMedCrossRefGoogle Scholar
  26. 26.
    Khanna N, et al. Cryptococcal infections of the central nervous system: an analysis of predisposing factors, laboratory findings and outcome in patients from South India with special reference to HIV infection. J Med Microbiol. 1996;45(5):376–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Liu TB, et al. Brain inositol is a novel stimulator for promoting cryptococcus penetration of the blood–brain barrier. PLoS Pathog. 2013;9(4):e1003247.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Perfect JR, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2010;50(3):291–322.PubMedCrossRefGoogle Scholar
  29. 29.
    Eghwrudjakpor PO, Allison AB. Neurocryptococcosis in a 10-year-old immunocompetent girl. Acta Neurochir (Wien). 2009;151(6):711–2; discussion 712.CrossRefGoogle Scholar
  30. 30.
    Voelz K, May RC. Cryptococcal interactions with the host immune system. Eukaryot Cell. 2010;9(6):835–46.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Mitchell TG, Perfect JR. Cryptococcosis in the era of AIDS – 100 years after the discovery of Cryptococcus neoformans. Clin Microbiol Rev. 1995;8(4):515–48.PubMedCentralPubMedGoogle Scholar
  32. 32.
    Davis JA, et al. Central nervous system involvement in cryptococcal infection in individuals after solid organ transplantation or with AIDS. Transpl Infect Dis. 2009;11(5):432–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Li Q, et al. Central nervous system cryptococcoma in immunocompetent patients: a short review illustrated by a new case. Acta Neurochir (Wien). 2010;152(1):129–36.CrossRefGoogle Scholar
  34. 34.
    Chuck SL, Sande MA. Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome. N Engl J Med. 1989;321(12):794–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Satishchandra P, et al. Cryptococcal meningitis: clinical, diagnostic and therapeutic overviews. Neurol India. 2007;55(3):226–32.PubMedCrossRefGoogle Scholar
  36. 36.
    Lee GJ, et al. Cerebral aspergillosis with multiple enhancing nodules in the right cerebral hemisphere in the immune-competent patient. J Korean Neurosurg Soc. 2013;53(5):312–5.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Kose S, et al. Central nervous system aspergillosis in an immunocompetent patient. J Infect Dev Ctries. 2011;5(4):313–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Lin SJ, Schranz J, Teutsch SM. Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis. 2001;32(3):358–66.PubMedCrossRefGoogle Scholar
  39. 39.
    Marr KA, et al. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34(7):909–17.PubMedCrossRefGoogle Scholar
  40. 40.
    Xess I, et al. Prevalence of Aspergillus species in clinical samples isolated in an Indian tertiary care hospital. Indian J Med Sci. 2004;58(12):513–9.PubMedGoogle Scholar
  41. 41.
    Bodey G, et al. Fungal infections in cancer patients: an international autopsy survey. Eur J Clin Microbiol Infect Dis. 1992;11(2):99–109.PubMedCrossRefGoogle Scholar
  42. 42.
    Walsh TJ, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(3):327–60.PubMedCrossRefGoogle Scholar
  43. 43.
    Kleinschmidt-DeMasters BK. Central nervous system aspergillosis: a 20-year retrospective series. Hum Pathol. 2002;33(1):116–24.PubMedCrossRefGoogle Scholar
  44. 44.
    Shamim MS, et al. Craniocerebral aspergillosis: a review of advances in diagnosis and management. J Pak Med Assoc. 2010;60(7):573–9.PubMedGoogle Scholar
  45. 45.
    Figueiredo EG, et al. Tumoral form of aspergillosis in central nervous system (cerebral aspergilloma): case report. Sao Paulo Med J. 2003;121(6):251–3.PubMedCrossRefGoogle Scholar
  46. 46.
    Verweij PE, et al. Aspergillus meningitis: diagnosis by non-culture-based microbiological methods and management. J Clin Microbiol. 1999;37(4):1186–9.PubMedCentralPubMedGoogle Scholar
  47. 47.
    Spampinato C, Leonardi D. Candida infections, causes, targets, and resistance mechanisms: traditional and alternative antifungal agents. Biomed Res Int. 2013;2013:204237.PubMedCentralPubMedGoogle Scholar
  48. 48.
    Sanchez-Portocarrero J, et al. The central nervous system and infection by Candida species. Diagn Microbiol Infect Dis. 2000;37(3):169–79.PubMedCrossRefGoogle Scholar
  49. 49.
    Parker Jr JC, McCloskey JJ, Lee RS. Human cerebral candidosis – a postmortem evaluation of 19 patients. Hum Pathol. 1981;12(1):23–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Nakayama H, et al. Histopathological study of candidal infection in the central nervous system. Nippon Ishinkin Gakkai Zasshi. 2010;51(1):31–45.CrossRefGoogle Scholar
  51. 51.
    Pfaller MA. Nosocomial candidiasis: emerging species, reservoirs, and modes of transmission. Clin Infect Dis. 1996;22 Suppl 2:S89–94.PubMedCrossRefGoogle Scholar
  52. 52.
    Casado JL, et al. Candidal meningitis in HIV-infected patients: analysis of 14 cases. Clin Infect Dis. 1997;25(3):673–6.PubMedCrossRefGoogle Scholar
  53. 53.
    Voice RA, et al. Chronic candidal meningitis: an uncommon manifestation of candidiasis. Clin Infect Dis. 1994;19(1):60–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Black KE, Baden LR. Fungal infections of the CNS: treatment strategies for the immunocompromised patient. CNS Drugs. 2007;21(4):293–318.PubMedCrossRefGoogle Scholar
  55. 55.
    Verduyn Lunel FM, et al. Detection of the Candida antigen mannan in cerebrospinal fluid specimens from patients suspected of having Candida meningitis. J Clin Microbiol. 2004;42(2):867–70.PubMedCentralPubMedCrossRefGoogle Scholar
  56. 56.
    Pappas PG, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(5):503–35.PubMedCrossRefGoogle Scholar
  57. 57.
    Edwards JA, Rappleye CA. Histoplasma mechanisms of pathogenesis – one portfolio doesn’t fit all. FEMS Microbiol Lett. 2011;324(1):1–9.PubMedCentralPubMedCrossRefGoogle Scholar
  58. 58.
    Ashford DA, et al. Outbreak of histoplasmosis among cavers attending the National Speleological Society Annual Convention, Texas, 1994. Am J Trop Med Hyg. 1999;60(6):899–903.PubMedGoogle Scholar
  59. 59.
    Jones TF, et al. Acute pulmonary histoplasmosis in bridge workers: a persistent problem. Am J Med. 1999;106(4):480–2.PubMedCrossRefGoogle Scholar
  60. 60.
    Wheat LJ, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45(7):807–25.PubMedCrossRefGoogle Scholar
  61. 61.
    Kauffman CA. Histoplasmosis: a clinical and laboratory update. Clin Microbiol Rev. 2007;20(1):115–32.PubMedCentralPubMedCrossRefGoogle Scholar
  62. 62.
    Wheat LJ, Musial CE, Jenny-Avital E. Diagnosis and management of central nervous system histoplasmosis. Clin Infect Dis. 2005;40(6):844–52.PubMedCrossRefGoogle Scholar
  63. 63.
    Bajwa S, Kulshrestha A. Fungal infections in intensive care unit: challenges in diagnosis and management. Ann Med Health Sci Res. 2013;3(2):238–44.PubMedCentralPubMedCrossRefGoogle Scholar
  64. 64.
    Klein CJ, et al. Central nervous system histoplasmosis mimicking a brain tumor: difficulties in diagnosis and treatment. Mayo Clin Proc. 1999;74(8):803–7.PubMedCrossRefGoogle Scholar
  65. 65.
    Kirkland TN, Fierer J. Coccidioidomycosis: a reemerging infectious disease. Emerg Infect Dis. 1996;2(3):192–9.PubMedCentralPubMedCrossRefGoogle Scholar
  66. 66.
    Saubolle MA, McKellar PP, Sussland D. Epidemiologic, clinical, and diagnostic aspects of coccidioidomycosis. J Clin Microbiol. 2007;45(1):26–30.PubMedCentralPubMedCrossRefGoogle Scholar
  67. 67.
    Galgiani JN, et al. Coccidioidomycosis. Clin Infect Dis. 2005;41(9):1217–23.PubMedCrossRefGoogle Scholar
  68. 68.
    Davis LE, Porter BS. Central nervous system Coccidioides immitis infections. Curr Treat Options Neurol. 2005;7(2):157–65.PubMedCrossRefGoogle Scholar
  69. 69.
    Kokseng SL, Blair JE. Successful kidney transplantation after coccidioidal meningitis. Transpl Infect Dis. 2011;13(3):285–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Mischel PS, Vinters HV. Coccidioidomycosis of the central nervous system: neuropathological and vasculopathic manifestations and clinical correlates. Clin Infect Dis. 1995;20(2):400–5.PubMedCrossRefGoogle Scholar
  71. 71.
    Lee CH, et al. Coccidioides immitis: two cases of misidentified mycosis. Can Respir J. 2008;15(7):377–9.PubMedCentralPubMedGoogle Scholar
  72. 72.
    Trible R, et al. Antiretroviral therapy-associated coccidioidal meningitis. Emerg Infect Dis. 2013;19(1):163–5.PubMedCentralPubMedCrossRefGoogle Scholar
  73. 73.
    Arsura EL, et al. Neuroimaging as a guide to predict outcomes for patients with coccidioidal meningitis. Clin Infect Dis. 2005;40(4):624–7.PubMedCrossRefGoogle Scholar
  74. 74.
    Stevens DA, Shatsky SA. Intrathecal amphotericin in the management of coccidioidal meningitis. Semin Respir Infect. 2001;16(4):263–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. 2000;13(2):236–301.PubMedCentralPubMedCrossRefGoogle Scholar
  76. 76.
    Waness A, Dawsari GA, Al Jahdali H. The rise of an opportunistic infection called “Invasive Zygomycosis”. J Glob Infect Dis. 2009;1(2):131–8.PubMedCentralPubMedCrossRefGoogle Scholar
  77. 77.
    Rahman A, et al. Rhino-orbital mucourmycosis in a non-immunocompromised patient. BMJ Case Rep. ;2013. pii:bcr2012007863.Google Scholar
  78. 78.
    Hopkins RJ, et al. Cerebral mucormycosis associated with intravenous drug use: three case reports and review. Clin Infect Dis. 1994;19(6):1133–7.PubMedCrossRefGoogle Scholar
  79. 79.
    Reinhardt DJ, et al. Experimental cerebral zygomycosis in alloxan-diabetic rabbits: variation in virulence among zygomycetes. Sabouraudia. 1981;19(4):245–56.PubMedCrossRefGoogle Scholar
  80. 80.
    Skiada A, et al. Disseminated zygomycosis with involvement of the central nervous system. Clin Microbiol Infect. 2009;15 Suppl 5:46–9.PubMedCrossRefGoogle Scholar
  81. 81.
    Reed C, et al. Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis. Clin Infect Dis. 2008;47(3):364–71.PubMedCentralPubMedCrossRefGoogle Scholar
  82. 82.
    Cornely OA, Vehreschild JJ, Ruping MJ. Current experience in treating invasive zygomycosis with posaconazole. Clin Microbiol Infect. 2009;15 Suppl 5:77–81.PubMedCrossRefGoogle Scholar
  83. 83.
    To CA, et al. Cryptococcal osteomyelitis and meningitis in a patient with non-hodgkin’s lymphoma treated with PEP-C. BMJ Case Rep. ;2012. pii: bcr0820114578.Google Scholar
  84. 84.
    Nguyen FN, et al. Isolated central nervous system histoplasmosis presenting with ischemic pontine stroke and meningitis in an immune-competent patient. JAMA Neurol. 2013;70(5):638–41.PubMedCrossRefGoogle Scholar
  85. 85.
    Louro R, et al. Fungal meningitis in an immunocompetent patient. Clin Drug Investig. 2013;33 Suppl 1:S47–50.PubMedCrossRefGoogle Scholar
  86. 86.
    Simsek H, et al. Concomitant tubercular and fungal cerebellar abscess in an immunocompromised girl. Turk Neurosurg. 2013;23(1):88–94.PubMedGoogle Scholar
  87. 87.
    Dusart A, et al. Fatal rhinocerebral mucormycosis with intracavernous carotid aneurysm and thrombosis: a late complication of transsphenoidal surgery? Acta Neurol Belg. 2013;113(2):179–84.PubMedCrossRefGoogle Scholar
  88. 88.
    Igusa R, et al. Escherichia coli pneumonia in combination with fungal sinusitis and meningitis in a tsunami survivor after the Great East Japan Earthquake. Tohoku J Exp Med. 2012;227(3):179–84.PubMedCrossRefGoogle Scholar
  89. 89.
    Kawakami Y, et al. Disseminated aspergillosis associated with tsunami lung. Respir Care. 2012;57(10):1674–8.PubMedCrossRefGoogle Scholar
  90. 90.
    Lokuhetty MD, et al. Iatrogenic Aspergillus infection of the central nervous system in a pregnant woman. Indian J Pathol Microbiol. 2009;52(3):427–9.PubMedCrossRefGoogle Scholar
  91. 91.
    Lanzafame M, et al. Rhodotorula glutinis-related meningitis. J Clin Microbiol. 2001;39(1):410.PubMedCentralPubMedCrossRefGoogle Scholar
  92. 92.
    Galhardo MC, et al. Sporothrix schenckii meningitis in AIDS during immune reconstitution syndrome. J Neurol Neurosurg Psychiatry. 2010;81(6):696–9.PubMedCrossRefGoogle Scholar
  93. 93.
    McNicholas S, et al. Sporobolomyces roseus in the cerebrospinal fluid of an immunocompetent patient – to treat or not to treat? J Med Microbiol. 2012;61(Pt 2):295–6.PubMedCrossRefGoogle Scholar
  94. 94.
    Gopinath M, et al. An elusive diagnosis: Scedosporium apiospermum infection after near-drowning. Ann Indian Acad Neurol. 2010;13(3):213–5.PubMedCentralPubMedCrossRefGoogle Scholar
  95. 95.
    Dobre MC, Smoker WR, Kirby P. A case of solitary Blastomyces dermatitidis meningitis. Clin Neurol Neurosurg. 2011;113(8):665–7.PubMedCrossRefGoogle Scholar
  96. 96.
    Romano A, et al. Pulmonary infection caused by Blastoschizomyces capitatus. Infez Med. 2005;13(3):187–91.PubMedGoogle Scholar
  97. 97.
    Poza G, et al. Meningitis caused by Pseudallescheria boydii treated with voriconazole. Clin Infect Dis. 2000;30(6):981–2.PubMedCrossRefGoogle Scholar
  98. 98.
    Shinde RS, Mantur BG, Patil G, Parande MV, Parande AM. Meningitis due to Rhodotorula glutinis in an HIV infected patient. Indian J Med Microbiol. 2008;26(4):375–7.PubMedCrossRefGoogle Scholar
  99. 99.
    Smith RM, et al. Fungal infections associated with contaminated methylprednisolone injections – preliminary report. N Engl J Med. 2013;369:1598–1609.Google Scholar
  100. 100.
    Staal JB, et al. Injection therapy for subacute and chronic low back pain: an updated Cochrane review. Spine (Phila Pa 1976). 2009;34(1):49–59.CrossRefGoogle Scholar
  101. 101.
    Hooten WM, Kinney MO, Huntoon MA. Epidural abscess and meningitis after epidural corticosteroid injection. Mayo Clin Proc. 2004;79(5):682–6.PubMedCrossRefGoogle Scholar
  102. 102.
    Cooper AB, Sharpe MD. Bacterial meningitis and cauda equina syndrome after epidural steroid injections. Can J Anaesth. 1996;43(5 Pt 1):471–4.PubMedCrossRefGoogle Scholar
  103. 103.
    Park MS, et al. Paraspinal abscess communicated with epidural abscess after extra-articular facet joint injection. Yonsei Med J. 2007;48(4):711–4.PubMedCentralPubMedCrossRefGoogle Scholar
  104. 104.
    Michal W, Olena W, Wojciech O. Bilateral endogenous fungal endophthalmitis. Int Ophthalmol. 2014;34:321–25.Google Scholar
  105. 105.
    Kim EC, Kim MS, Kang NY. Fungal corneal ulcer and bacterial orbital cellulitis occur as complications of bacterial endophthalmitis after cataract surgery in an immunocompetent patient. Semin Ophthalmol. 2013;28(2):75–8.PubMedCrossRefGoogle Scholar
  106. 106.
    Ostensson A, Geborek P. Septic arthritis as a non-surgical complication in rheumatoid arthritis: relation to disease severity and therapy. Br J Rheumatol. 1991;30(1):35–8.PubMedCrossRefGoogle Scholar
  107. 107.
    Centers for Disease, C. and Prevention. Exophiala infection from contaminated injectable steroids prepared by a compounding pharmacy – United States, July-November 2002. MMWR Morb Mortal Wkly Rep. ;51(49):1109–12.Google Scholar
  108. 108.
    Smith RM, et al. Relapse of fungal meningitis associated with contaminated methylprednisolone. N Engl J Med. 2013;368(26):2535–6.PubMedCrossRefGoogle Scholar
  109. 109.
    Centers for Disease, C. and Prevention. Multistate outbreak of fungal infection associated with injection of methylprednisolone acetate solution from a single compounding pharmacy – United States, 2012. MMWR Morb Mortal Wkly Rep. ;61(41):839–42.Google Scholar
  110. 110.
    Centers for Disease, C. and Prevention. Multistate fungal meningitis outbreak – interim guidance for treatment. MMWR Morb Mortal Wkly Rep. ;61(41):842.Google Scholar
  111. 111.
    Croxatto A, Prod’hom G, Greub G. Applications of MALDI-TOF mass spectrometry in clinical diagnostic microbiology. FEMS Microbiol Rev. 2012;36(2):380–407.PubMedCrossRefGoogle Scholar
  112. 112.
    Kastrup O, Wanke I, Maschke M. Neuroimaging of infections. NeuroRx. 2005;2(2):324–32.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Mansa Amul Munshi
    • 1
  • Antonella Rella
    • 1
  • Maurizio Del Poeta
    • 1
    Email author
  1. 1.Department of Molecular Genetics and MicrobiologyStony Brook UniversityStony BrookUSA

Personalised recommendations