The Lancet regional health. Southeast Asia · 2026
Invasive mould infections of the central nervous system in the Indian population: a cohort study (2004-2025).
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Kaur Harsimran, Rudramurthy Shivaprakash M, Kanaujia Rimjhim, Ahmad Haseen, Salunke Pravin, Bansal Deepak, Gupta Kirti, Chatterjee Debajyoti, Ahuja Chirag Kamal, Kapila Aastha Takkar, Modi Manish, Mohindra Sandeep, Chhabra Rajesh, Karthigeyan Madhivanan, Singh Harpreet, Singh Apinderpreet, Agarwal Ashish, Verma Sanjay, Gupta Sunil Kumar, Jain Sanjay, Trehan Amita, Vyas Sameer, Pandiarajan Vignesh, Ghosh Anup, Chakrabarti Arunaloke
Аннотация
BACKGROUND: Central nervous system (CNS) invasive mould infection (IMI) is a rare but life-threatening condition. Limited large-scale studies hinder the understanding of its clinical characteristics and optimal management strategies.
METHODS: This was a cohort study. We reviewed confirmed patients of CNS IMI (January 2004-March 2025) by microbiological (direct microscopy and/or culture) and/or histopathological evidence at our tertiary care hospital. Clinical, demographic and mycological characteristics were analysed and compared.
FINDINGS: Among 1321 brain abscess/biopsy samples, 127 patients (9.6%) were of fungal origin (adults, 100; paediatrics, 27). The median age was 30 (IQR: 27) years, with male predominance (71.7%). Adults were significantly infected by melanized fungi (p = 0.003). Seventy-four percent of patients had no identifiable underlying immunocompromising condition. The median duration of symptoms was 15 days (IQR: 23 days), including headache (61.4%) and seizures (50.4%). Frequency of fever was significantly higher in infection by melanized fungi (p = 0.02). Frontal lobe involvement was common in paediatric age (OR 0.379, 95% CI 0.141-1.019; p = 0.05). Aspergillus spp. (56.3%) and Cladophialophora bantiana (21.36%) were the predominant pathogens. Deniquelata barringtoniae was reported as a human pathogen. Voriconazole (61.4%) and liposomal amphotericin B (28.3%) were the primary antifungals used. Surgical intervention was performed in all patients. Partial excision (66.7% vs 38.0%, OR 0.306, 95% CI 0.125-0.751; p = 0.01) and use of liposomal amphotericin B (55.6% vs 21%, OR 0.213, 95% CI 0.087-0.522 p = 0.001) were common in paediatric patients. The overall mortality was 30.7%, complete excision was significantly more frequent among survivors than non-survivors (67.0% vs 30.8%; OR 0.218, 95% CI 0.097-0.492; p = 0.001). Lack of headache (p = 0.044) and partial excision surgery (p = 0.001) were independently associated with poor outcome.
INTERPRETATION: We describe a compendium of CNS IMI in patients from India, highlighting distinct clinical patterns and treatment outcomes across age groups and fungal types. This warrants investigation of host and pathogen-related factors in the country.
FUNDING: Funding included Department of Science and Technology-Science and Engineering Research Board (DST-SERB), New Delhi, India and Indian Council of Medical Research (ICMR), New Delhi, India.
METHODS: This was a cohort study. We reviewed confirmed patients of CNS IMI (January 2004-March 2025) by microbiological (direct microscopy and/or culture) and/or histopathological evidence at our tertiary care hospital. Clinical, demographic and mycological characteristics were analysed and compared.
FINDINGS: Among 1321 brain abscess/biopsy samples, 127 patients (9.6%) were of fungal origin (adults, 100; paediatrics, 27). The median age was 30 (IQR: 27) years, with male predominance (71.7%). Adults were significantly infected by melanized fungi (p = 0.003). Seventy-four percent of patients had no identifiable underlying immunocompromising condition. The median duration of symptoms was 15 days (IQR: 23 days), including headache (61.4%) and seizures (50.4%). Frequency of fever was significantly higher in infection by melanized fungi (p = 0.02). Frontal lobe involvement was common in paediatric age (OR 0.379, 95% CI 0.141-1.019; p = 0.05). Aspergillus spp. (56.3%) and Cladophialophora bantiana (21.36%) were the predominant pathogens. Deniquelata barringtoniae was reported as a human pathogen. Voriconazole (61.4%) and liposomal amphotericin B (28.3%) were the primary antifungals used. Surgical intervention was performed in all patients. Partial excision (66.7% vs 38.0%, OR 0.306, 95% CI 0.125-0.751; p = 0.01) and use of liposomal amphotericin B (55.6% vs 21%, OR 0.213, 95% CI 0.087-0.522 p = 0.001) were common in paediatric patients. The overall mortality was 30.7%, complete excision was significantly more frequent among survivors than non-survivors (67.0% vs 30.8%; OR 0.218, 95% CI 0.097-0.492; p = 0.001). Lack of headache (p = 0.044) and partial excision surgery (p = 0.001) were independently associated with poor outcome.
INTERPRETATION: We describe a compendium of CNS IMI in patients from India, highlighting distinct clinical patterns and treatment outcomes across age groups and fungal types. This warrants investigation of host and pathogen-related factors in the country.
FUNDING: Funding included Department of Science and Technology-Science and Engineering Research Board (DST-SERB), New Delhi, India and Indian Council of Medical Research (ICMR), New Delhi, India.