Mem Inst Oswaldo Cruz, Rio de Janeiro, VOLUME 118 | 2023
Perspective

Cerebrospinal fluid: a target of some fungi and an overview

Danielly Corrêa-Moreira1,+, Rodolfo Castro2,3, Gisela Lara da Costa1, Reginaldo Gonçalves Lima-Neto4, Manoel Marques Evangelista Oliveira1,+

1Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Taxonomia, Bioquímica e Bioprospecção de Fungos, Rio de Janeiro, RJ, Brasil
2Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública, Rio de Janeiro, RJ, Brasil
3Universidade Federal do Rio de Janeiro, Instituto de Saúde Coletiva, Rio de Janeiro, RJ, Brasil
4Universidade Federal de Pernambuco, Recife, PE, Brasil

DOI: 10.1590/0074-02760220251
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ABSTRACT

Meningitis is a potentially life-threatening infection characterised by the inflammation of the leptomeningeal membranes. The estimated annual prevalence of 8.7 million cases globally and the disease is caused by many different viral, bacterial, and fungal pathogens. Although several genera of fungi are capable of causing infections in the central nervous system (CNS), the most significant number of registered cases have, as causal agents, yeasts of the genus Cryptococcus. The relevance of cryptococcal meningitis has changed in the last decades, mainly due to the increase in the number of people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and medications that impair the immune responses. In this context, coronavirus disease 19 (COVID-19) has also emerged as a risk factor for invasive fungal infections (IFI), including fungal meningitis (FM), due to severe COVID-19 disease is associated with increased pro-inflammatory cytokines, interleukin (IL)-1, IL-6, and tumour necrosis factor-alpha, reduced CD4-interferon-gamma expression, CD4 and CD8 T cells. The gold standard technique for fungal identification is isolating fungi in the culture of the biological material, including cerebrospinal fluid (CSF). However, this methodology has as its main disadvantage the slow or null growth of some fungal species in culture, which makes it difficult to finalise the diagnosis. In conclusions, this article, in the first place, point that it is necessary to accurately identify the etiological agent in order to assist in the choice of the therapeutic regimen for the patients, including the implementation of actions that promote the reduction of the incidence, lethality, and fungal morbidity, which includes what is healthy in the CNS.

key words: fungal meningitis diagnosis cerebrospinal fluid
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Financial support: CAPES (DC-M fellowship 88882.317297/2019-01), FAPERJ (Grants: JCNE E-26/203.301/2017, JCNE E-26/201.433/2021 - MMEO), CNPq (Grant Proc. 409227/2016-1 - MMEO).
+ Corresponding authors: dcorrea@ioc.fiocruz.br / manoel.marques@ioc.fiocruz.br
ORCID https://orcid.org/0000-0002-0931-4204
ORCID https://orcid.org/0000-0001-7670-9225
Received 29 October 2022
Accepted 14 February 2023

HOW TO CITE
Corrêa-Moreira D, Castro R, da Costa GL, Lima-Neto RG, Oliveira MME. Cerebrospinal fluid: a target of some fungi and an overview. Mem Inst Oswaldo Cruz. 2023; 118: e220251.

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