Neuromycoses: recognition and management in clinical practice

Neuromycoses encompass fungal infections of the central nervous system (CNS). Their prevalence is increasing worldwide, with significant morbidity and mortality. Many carry a high mortality and so a knowledge of these conditions is important to facilitate rapid identification and treatment. There are no effective laboratory diagnostics for many neuromycoses. Negative cultures, absence of systemic inflammation and normal cerebrospinal fluid results do not exclude neuromycoses. Diagnosis can however often be deduced based on the specific constellation of exposure, travel and host factors. Management is difficult due to paucity of evidence, limited CNS penetration of antifungal agents and their significant toxicity. It is important to identify the causative organism due to highly variable susceptibility profiles. Treatment success is primarily evaluated based on symptom improvement. This review aims to arm clinicians with the broad knowledge required to diagnose and treat these rare, yet important, conditions with significant clinical consequences.