| REVIEW ARTICLE |
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| Year : 2007 | Volume
: 55
| Issue : 3 | Page : 251--259 |
Fungal infections of the central nervous system: A review of fungal pathogens and treatment
Andrew Redmond1, Craig Dancer2, Marion L Woods3
1 Princess Alexandra Hospital, Department of Microbiology, Brisbane; University of Queensland, Adelaide, Australia
2 Institute of Veterinary and Medical Science, Adelaide, Australia
3 University of Queensland, Adelaide; The Royal Brisbane and Women's Hospital, Brisbane, Australia
Correspondence Address:
Marion L Woods
Department of Infectious Diseases, The Royal Brisbane and Women's Hospital, Herston 4029, Queensland
Australia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.35686
Multiple factors influence the outcome of fungal infection of the central nervous system (CNS). The host and the pathogen in concert with drug delivery across the blood-brain barrier and drug activity are key factors in outcome. Drug costs can be prohibitively expensive. Drug toxicity with standard antifungal agents such as amphotericin B (infusion rate toxicity) can be reduced using simple techniques such as slower infusion and appropriate saline loading. Continuous infusion can allow relatively large doses of amphotericin B (up to 2 mg/kg/day, remaining below 0.08 mg/kg/hour) to be given with toxicity profiles comparable to expensive lipid formulations of amphotericin B. Dedicated peripherally inserted central catheters can remain in situ for weeks to months and are safe and relatively inexpensive. Correction of metabolic pathology in the case of mucormycosis and resolution of neutropenia are essential to effective treatment of filamentous fungal infections such as Mucor, Aspergillus and Scedosporium . The pharmacology and pharmacokinetics of the current major antifungal agents used to treat fungal infections of the CNS are reviewed. Tables that provide information about achievable CNS drug levels, antifungal susceptibilities and the likelihood of intrinsic drug resistance of significant fungal pathogens have been included to help the clinician with therapy. Treatment recommendations for Cryptococcal and Candida meningitis and for rhinocerebral infection with Mucor and Aspergillus have been included.
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