Fungal infections of the central nervous system (CNS) were considered rare until the 1970s. This is no longer true in recent years due to widespread use of
corticosteroids, cytotoxic drugs and
antibiotics. Immunocompromised patients with underlying
malignancy organ transplantations and
acquired immune deficiency syndrome are all candidates for acquiring
fungal infections either in meninges or brain. A considerable number of cases of
CNS fungal infections even in immunocompetent hosts have been reported. A vast array of fungi may cause
infection in the CNS, but barring a few, most of them are anecdotal case reports. Cryptococcus neoformans, Candida albicans, Coccidioides immitis. Histoplasma capsulatum are common causes of
fungal meningitis; Aspergillus spp, Candida spp, Zygomycetes and some of the melanized fungi are known to cause mass lesions in brain. Few fungi like C. neoformans, Cladophialophora bantiana, Exophiala dermatitidis, Ramichloridium mackenzie, Ochroconis gallopava are considered as true neurotropic fungi. Most of the fungi causing
CNS infection are saprobes with worldwide distribution; a few are geographically restricted like Coccidioides immitis. The
infections reach the CNS either by the hematogenous route or by direct extension from colonized sinuses or ear canal or by direct inoculation during
neurosurgical procedures.