Caceres Adrian, Avila Maria Luisa, Herrera Marco Luis
Neurosurgery Department, National Children's Hospital of Costa Rica, Paseo Colón y Calle 20 sur, San José, 10103, Costa Rica.
Infectious Diseases Department, National Children's Hospital of Costa Rica, San José, Costa Rica.
Childs Nerv Syst. 2018 Oct;34(10):1973-1988. doi: 10.1007/s00381-018-3942-3. Epub 2018 Aug 18.
Invasive mycosis of the central nervous system represent a diverse group of diseases that have gradually emerged as not only opportunistic infections in patients with immune susceptibility due to congenital and acquired deficiency, immunomodulation, solid organ and stem cell transplantation, hematological malignancies, and chronic steroid use but also in selected risk populations such as low weight preterm infants, patients with shunted hydrocephalus and external ventricular drainages, skull base surgery, and head injury.
The purpose of this review is to familiarize the pediatric neurosurgeon with the most common mycosis and their clinical scenarios which can be encountered in the clinical practice, with special emphasis on clinical, radiological, and laboratory diagnosis beyond classical microorganism cultures as well as options in medical and surgical treatment given the high incidence of morbidity and mortality associated with these challenging entities.
We conducted an online database review (Ovid, PubMed) gathering relevant English language literature published in the last 20 years with special emphasis on recent breakthroughs in the diagnosis and treatment of invasive mycosis of the CNS as well as reported cases within the pediatric neurosurgical literature and their surgical management.
Fungal agents capable of invading the CNS can behave as aggressive entities with rapid progression manifesting as overwhelming meningoencephalitis with vascular compromise or can lead to space-occupying lesions with abscess formation which require prompt diagnosis by either laboratory identification of the components of these biological agents and their host response or by obtaining tissue specimens for microbiological identification which may not be straightforward due to prolonged culture time.
Following a high degree of suspicion with prompt initiation of antifungal agents and reversal of potential immunosuppressant therapies along with neurosurgical evacuation of intracranial collections or removal of infected hardware (CSF shunts) can lead to more optimistic outcomes of these complex clinical scenarios.
中枢神经系统侵袭性真菌病是一组多样的疾病，不仅逐渐成为先天性和后天性免疫缺陷、免疫调节、实体器官和干细胞移植、血液系统恶性肿瘤以及长期使用类固醇等免疫易感患者的机会性感染，还见于特定风险人群，如低体重早产儿、行分流性脑积水和外置脑室引流术的患者、颅底手术患者以及头部受伤患者。
本综述旨在使儿科神经外科医生熟悉临床实践中可能遇到的最常见真菌病及其临床情况，特别强调除传统微生物培养外的临床、放射学和实验室诊断，以及鉴于这些具有挑战性疾病的高发病率和死亡率而在药物和手术治疗方面的选择。
我们进行了在线数据库检索（Ovid、PubMed），收集过去20年发表的相关英文文献，特别关注中枢神经系统侵袭性真菌病诊断和治疗的最新突破以及儿科神经外科文献中报道的病例及其手术管理。
能够侵袭中枢神经系统的真菌病原体可表现为具有快速进展的侵袭性实体，表现为伴有血管损害的暴发性脑膜脑炎，或可导致形成脓肿的占位性病变，这需要通过实验室鉴定这些生物病原体的成分及其宿主反应，或通过获取组织标本进行微生物鉴定来迅速诊断，由于培养时间长，这可能并非易事。
高度怀疑后迅速启动抗真菌药物并停用潜在的免疫抑制疗法，同时通过神经外科手术清除颅内病灶或移除受感染的硬件（脑脊液分流管），可使这些复杂临床情况的结果更为乐观。
