TY - JOUR
T1 - Advances in the diagnosis and treatment of fungal infections of the CNS
AU - Schwartz, Stefan
AU - Kontoyiannis, Dimitrios P.
AU - Harrison, Thomas
AU - Ruhnke, Markus
N1 - Funding Information:
SS reports personal fees (speaker, advisory board membership honoraria, or both) and travel grants from AMGEN, Basilea Pharmaceutica, Gilead Sciences, Jazz Pharmaceuticals, MSD Sharp & Dohme, and Pfizer, and has served as a consultant for AMGEN. DPK reports research support from Merck & Co, Pfizer, Astellas Pharma and honoraria from Merck & Co, Amplyx Pharmaceuticals, Astellas Pharma, Gilead Sciences, Pfizer, Cidara Therapeutics, and Jazz Pharmaceuticals, and has served as a consultant for Astellas Pharma, Merck & Co, and Pfizer. TH reports a grant (investigator award to institution) from Gilead Sciences, speaker honoraria from Pfizer, advisory board membership honoraria from Viamet Pharmaceuticals, and non-financial support (tests for research use) from ImmunoMycologics. MR reports speaker honoraria and expert testimony from Janssen Pharmaceutica and Basilea Pharmaceutica, and has served as a consultant for Janssen Pharmaceutica and Basilea Pharmaceutica.
Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2018/4
Y1 - 2018/4
N2 - Fungal infections of the CNS are challenging to treat and their optimal management requires knowledge of their epidemiology, host characteristics, diagnostic criteria, and therapeutic options. Aspergillus and Cryptococcus species predominate among fungal infections of the CNS. Most of these fungi are ubiquitous, but some have restricted geographical distribution. Fungal infections of the CNS usually originate from primary sites outside the CNS (eg, fungal pneumonia) or occur after inoculation (eg, invasive procedures). Most patients with these infections have immunodeficiencies, but immunocompetent individuals can also be infected through heavy exposure. The infecting fungi can be grouped into moulds, yeasts, and dimorphic fungi. Substantial progress has been made with new diagnostic approaches and the introduction of novel antifungal drugs, but fungal infections of the CNS are frequently lethal because of diagnostic delays, impaired drug penetration, resistance to antifungal treatments, and inadequate restoration of immune function. To improve outcomes, future research should advance diagnostic methods (eg, molecular detection and fungus identification), develop antifungal compounds with enhanced CNS-directed efficacy, and further investigate crucial host defence mechanisms.
AB - Fungal infections of the CNS are challenging to treat and their optimal management requires knowledge of their epidemiology, host characteristics, diagnostic criteria, and therapeutic options. Aspergillus and Cryptococcus species predominate among fungal infections of the CNS. Most of these fungi are ubiquitous, but some have restricted geographical distribution. Fungal infections of the CNS usually originate from primary sites outside the CNS (eg, fungal pneumonia) or occur after inoculation (eg, invasive procedures). Most patients with these infections have immunodeficiencies, but immunocompetent individuals can also be infected through heavy exposure. The infecting fungi can be grouped into moulds, yeasts, and dimorphic fungi. Substantial progress has been made with new diagnostic approaches and the introduction of novel antifungal drugs, but fungal infections of the CNS are frequently lethal because of diagnostic delays, impaired drug penetration, resistance to antifungal treatments, and inadequate restoration of immune function. To improve outcomes, future research should advance diagnostic methods (eg, molecular detection and fungus identification), develop antifungal compounds with enhanced CNS-directed efficacy, and further investigate crucial host defence mechanisms.
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U2 - 10.1016/S1474-4422(18)30030-9
DO - 10.1016/S1474-4422(18)30030-9
M3 - Review article
C2 - 29477506
AN - SCOPUS:85042311751
SN - 1474-4422
VL - 17
SP - 362
EP - 372
JO - The Lancet Neurology
JF - The Lancet Neurology
IS - 4
ER -