Fungal and Parasitic Infections of the CNS - Inova Health System

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Coccidioides immitis • Usually PATHOGENIC infection, occasionally OPPORTUNISTIC • Epidemiology: Argentina, Paraguay, Mexico, southwestern USA • Pathogenic infection: mild febrile illness followed relatively frequently by lung infection which may be clinically overlooked • Predilection for CNS: Nervous system is involved in 1/3 of cases even in non-immunocompromised hosts • Large granulomatous lesions rarely described but usually numerous small nodular granulomas occur at base of brain, necrotize and coalesce leading to basilar meningitis (granulomatous + purulent) • CNS vasoinvasion sometimes occurs Basilar meningitis Coccidioides immitis Coccidioides immitis • Morphology of fungus: -20-35 micron spherules (sporangia) containing endospores, seen easily on H&E, often in giant cells - PAS+ endospores - In nature, and exceedingly rarely in CNS, exist as hyphae with arthrospores 8
Coccidioides immitis can be vasoinvasive under the right circumstances C. immitis in an AIDS patient Cladosporium trichoides • PATHOGENIC infection, occasionally OPPORTUNISTIC • Rare organism that causes multiple brain abscesses • PIGMENTED (dematiaceous), brown fungus on H&E • GMS shows budding yeast that elongate into hyphae with rare branching 9
Page 1 and 2: Fungal and Parasitic Infections of
Page 3 and 4: Taxonomy simplified for the rest of
Page 5 and 6: Am J Surg Path 2007; 31:615-623 Bla
Page 7: Uncommon, localized granuloma in CN
Page 11 and 12: Spectrum exists from bland infarcti
Page 13 and 14: Aspergillus look-alikes • Cannot
Page 15 and 16: • Morphology: - Broad hyphae 10-1
Page 17 and 18: Candida look-alikes • Torulopsis
Page 19 and 20: Nocardia and Actinomyces • Morpho
Page 21 and 22: CNS Metazoal infections: trematodes
Page 23 and 24: Lifecycle Adult tapeworm Cysticercu
Page 25 and 26: T1 Diagnosis Radiology • Scolex i
Page 27 and 28: Ameba • Entamoeba histolytica - S
Page 29 and 30: Balamuthia mandrillaris • Childre
Page 31: cysticercosis, toxoplasmosis, and t

Fungal and Parasitic Infections of the CNS - Inova Health System

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