Central Nervous System Fungal Infections, Diagnostics, and Antifungals: Is There “Mush-room” for Improvement?

The blood brain barrier (BBB) controls the passage of molecules between the circulatory system and the central nervous system. Despite this, some fungi find ways to bypass the BBB, resulting in infections of the central nervous system (CNS) including meningitis, meningoencephalitis, and abscesses. While these infections are rare, the resultant mortality rates range from 30 to 99%, in part due to the poor penetration of most commercially available antifungals. Additionally, laboratory diagnostics can lack sensitivity and/or specificity and may require specialized diagnostic testing facilities, also contributing to the high mortality rate seen in CNS mycoses. Despite the high risk of mortality, detailed understanding of how these infections occur is limited to only a few of the most common fungi, and there is a dearth of research examining novel therapies to aid in the treatment of these infections.