Pathology of fungal infections of the central nervous system: 17 years' experience from Southern India

Aims:  To describe the pathology of central nervous system (CNS) fungal infections with particular reference to India. Methods and results:  This was a retrospective study from 1988 to 2004 constituting 130 cases. The diagnosis was based on morphology of biopsy/autopsy material. These included aspergillosis (n = 73), zygomycosis (n = 40), cryptococcosis (n = 2), rhodotorulosis (n = 1), candidiasis (n = 5), maduramycosis (n = 1), pheohyphomycosis (n = 3) and mixed infections (n = 5). Predisposing risk factors were present in 49 (38%) patients only. The majority of the patients were immunocompetent. The commonest risk factor was diabetes mellitus, the commonest route of infection was from a contiguous site and the commonest pathology was granuloma. Culture positivity was seen in only 31%. Conclusion:  Environmental factors in tropical countries such as India play a significant role in the pathogenesis of CNS fungal infections.