Department of Pediatric Neurology and Neurodevelopment, Medanta, The Medicity, Gurgaon, Haryana, India.
Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Indian J Pediatr. 2019 Jan;86(1):83-90. doi: 10.1007/s12098-017-2487-x. Epub 2017 Nov 11.
Central nervous system fungal infections can be broadly divided into those that infect a healthy host such as Cryptococcus, Coccidioides, Histoplasma, Blastomyces, Sporothrix spp., and those that cause opportunistic infections in an immunocompromised host such as Candida, Aspergillus, Zygomycetes, Trichosporon spp. The clinical manifestations of central nervous system fungal infections commonly seen in children in clinical practice include a chronic meningitis or meningoencephalitis syndrome, brain abscess, rhino-cerebral syndrome and rarely, a fungal ventriculitis. Fungal central nervous system infections should be suspected in any child with subacute to chronic febrile encephalopathy or meningitis with or without raised intracranial pressure, seizures, orbital pain and/or sero-sanguinous nasal discharge. Diagnosis is corroborated by cerebrospinal fluid analysis, culture and PCR, special stains, serological tests and neuroimaging. Management of fungal central nervous system infections include specific antifungal therapy and supportive measures for associated problems, management of underlying predisposing condition and surgical intervention in cases with localized disease, abscess or presence of simultaneous foreign body such as intracranial shunts. In addition to the fungi, several parasitic infections can cause central nervous system infections in children. Of these, authors briefly discuss cerebral malaria, and amebic meningo-encephalitis.
一类是侵袭健康宿主的真菌，如隐球菌、球孢子菌、组织胞浆菌、芽生菌和孢子丝菌；另一类是在免疫功能低下宿主中引起机会性感染的真菌，如念珠菌、曲霉菌、接合菌、毛孢子菌等。在临床实践中，儿童常见的中枢神经系统真菌感染的临床表现包括慢性脑膜炎或脑膜脑炎综合征、脑脓肿、鼻-脑真菌病，偶尔也有真菌性脑室炎。任何有亚急性至慢性发热性脑病或伴有或不伴有颅内压升高、癫痫发作、眶周疼痛和/或浆液血性鼻漏的脑膜炎患儿，均应怀疑有中枢神经系统真菌感染。诊断依据包括脑脊液分析、培养和 PCR、特殊染色、血清学检查和神经影像学检查。中枢神经系统真菌感染的治疗包括针对特定真菌的抗真菌治疗和针对相关问题的支持性治疗，以及对潜在诱发因素的治疗和对局部疾病、脓肿或同时存在颅内分流等异物的手术干预。除了真菌，还有几种寄生虫感染也可导致儿童中枢神经系统感染。作者简要讨论了疟疾性脑病和阿米巴脑膜脑炎。
