Abstract

Primary fungal infection of the central nervous system (CNS) is rare but often associated with severe prognosis. Diagnosis is complicated since cerebrospinal fluid (CSF) samples obtained from lumbar puncture usually remain sterile. Testing for fungal antigens in CSF could be a complementary diagnostic tool. We conducted such measurements in CSF from patients with CNS fungal infection and now discuss the usefulness of ventricular puncture. Mannan and (1→3)ß-D-glucan (BDG) testing were retrospectively performed in CSF samples from three patients with proven chronic CNS fungal infection (excluding Cryptococcus), and subsequently compared to 16 controls. Results from lumbar punctures and those from cerebral ventricles were confronted. BDG detection was positive in all the CSF samples (from lumbar and/or ventricular puncture) from the three confirmed cases. In case of Candida infection, mannan antigen measurement was positive in 75% of the CSF samples. In the control group, all antigen detections were negative (n = 15), except for one false positive. Faced with suspected chronic CNS fungal infection, measurement of BDG levels appears to be a complementary diagnostic tool to circumvent the limitations of mycological cultures from lumbar punctures. In the event of negative results, more invasive procedures should be considered, such as ventricular puncture.

中文翻译：

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挑战性诊断慢性脑真菌感染：（1→3）-ß-D-葡聚糖和甘露聚糖抗原检测在脑脊液和脑室穿刺中的价值。

摘要

原发性真菌感染中枢神经系统（CNS）很少，但通常与严重的预后相关。由于腰椎穿刺获得的脑脊液（CSF）样品通常保持无菌，因此诊断非常复杂。在脑脊液中检测真菌抗原可能是一种辅助诊断工具。我们在中枢神经系统真菌感染患者的脑脊液中进行了此类测量，现在讨论了心室穿刺的有用性。对三名经证实患有慢性中枢神经系统真菌感染（隐球菌除外）的患者的脑脊液样本进行了甘露聚糖和（1→3）β-D-葡聚糖（BDG）检测），然后与16个控件进行比较。面对腰椎穿刺和脑室穿刺的结果。在三例确诊病例中，所有脑脊液样本（来自腰椎和/或心室穿刺）的BDG检测均为阳性。在念珠菌感染的情况下，75％的CSF样品中甘露聚糖抗原检测呈阳性。在对照组中， 除一次假阳性外，所有抗原检测均为阴性（n = 15）。面对疑似的慢性中枢神经系统真菌感染，测量BDG水平似乎是一种辅助的诊断工具，可避免腰穿引起的真菌培养的局限性。如果结果为阴性，应考虑采用更具侵入性的程序，例如心室穿刺。