Central Nervous System Fungal Infections in Pakistan: A Narrative Review and Descriptive Synthesis

Central nervous system (CNS) fungal infections are associated with significant morbidity and mortality globally, especially in immunocompromised patients. This narrative review aimed to characterise the spectrum of CNS fungal infections in Pakistan. Overall, 14 studies with histologically confirmed diagnoses of CNS fungal infection were included, comprising data on 140 patients. The average age was 38.7 years with male predominance. The most common presenting symptom was headache in 58 (41.42%), followed by visual disturbance in 27 (19.28%) and limb weakness in 22 (15.71%). Among all patients, 31 (22.14%) had a history of diabetes mellitus. Aspergillus was the most frequently isolated pathogen in 46 (32.85%) patients, followed by Mucorales in 42 (30%) patients. Combined medical and surgical management was used in 113 (80.71%) cases. The primary antifungal treatment administered was amphotericin B and voriconazole in 82 (58.57%) and 41 (29.28%) patients, respectively. The surgical management included neuronavigation-guided biopsy in 29 (20.71%), endoscopic debridement in 16 (11.42%), and subtotal resection in 15 (10.71%). The combined medical and surgical management resulted in clinical improvement in 57 (50.44%) patients and mortality in 41 (36.28%) patients. Among the patients given only medical therapy, mortality occurred in 17 (65.38%) patients, and resolution occurred in 2 (7.69%) patients. This review demonstrates that CNS fungal infections in Pakistan often present with nonspecific symptoms. Diabetes mellitus was the most commonly reported comorbidity. The management is multimodal, with combined medical and surgical management required in the majority of patients. Despite treatment, mortality remains high, emphasising the need for earlier diagnosis.