Candida abscess:
Diagnosis:
Biopsy or blood culture isolation of organisms
Treatment:
Fluconazole, amphotericin B
Cryptococcosis (Cryptococcus neoformans):
See under Cryptococcosis (Cryptococcus neoformans), Cryptococcal meningitis & related
Aspergillosis a.k.a. Aspergillus fumigatus or flavus:
Diagnosis:
Suggested by MRI, but confirmed by biopsy
Pathology:
Biopsy:
- Within distribution of anterior or middle cerebral artery. Multiple. Necrosis, hemorrhage.
- Microscopy: hyphae branching at acute angles, septate. Vascular invasion, thromobosis & necrosis. Neutrophil or granulomatous infiltrate,
CT: same features of abscess but in a vascular distribution with occasional infarcts
MRI:
- Well formed capsule, features of infarction may be present,
- T2/FLAIR: high intensity
- T1: may have high intensity
Treatment:
Amphotericin +flucytocine
Itraconazole
Surgical debridement
Mucormycosis a.k.a. rhinocerebralmucormycosis a.k.a. zygomycosis, Causative agent Rhizopus arrhisus, Absidiacorymbifera:
Diagnosis:
Isolation of organism in setting of appropriate clinical and imaging findings
Pathology and microbiology:
CSF analysis: India Ink stain fungal hyphae
Palate biopsy & culture: HE fungal hyphae invading vessels (broad hyphae). Globular bodies
Fungal RNA analysis: 16s rRNA gene sequence analysis
Causative agent: Rhizopus arrhisus, Absidia corymbifera
Findings on Investigations:
CT/MRI:
- Strokes
- Sinusitis, orbital cellulitis
Treatment:
Amphotericin B, itraconazole
Surgical debridement