Cryptococcal and Other Fungal Infections of the Central Nervous System

Any fungus that becomes blood-borne might be expected to lodge in the central nervous system (CNS) and cause disease. Yet, only relatively few fungi cause infections of the CNS with sufficient frequency to merit thorough consideration. For example, in 8,975 complete autopsies carried out from 1964 to 1976 in the southeastern United States,1 Candida spp accounted for 19 of 39 cerebral mycoses. However, candidosis of the CNS is rarely diagnosed premortem despite the fact that candidemia is the most common fungemia.2 In this chapter, discussion will be limited to the three most frequent mycoses of the CNS in the United States—those caused by Cryptococcus neoformans, Zygomycetes, and Coccidioides immitis.