Table 5.

Studies and Significant Findings on Adjunctive Steroid Therapy for Fungal and Parasitic CNS Infection.

Reference	Pathogen	N	Primary Findings	Type of Study
Murdoch et al., 2007	C. neoformans or C. gatti	–	Across small studies and anecdotal benefits, it is reasonable to administer systemic corticosteroids to alleviate unresponsive inflammatory effects.	Meta analysis
Beardsley et al., 2016	C. neoformans or C. gatti	451	Studied use of adjunctive dexamethasone steroid therapy in combination with antifungal treatments, amphotericin B and fluconazole, for six weeks. Mortality rate of 47% with dexamethasone treatment and 41% in the placebo group (10 weeks) and 57% mortality with dexamethasone treatment in comparison to the placebo of 47% (6 months). Disability and adverse effects higher in dexamethasone-treated groups by 10 weeks of treatment.	RCT
Perfect et al., 2018	C. neoformans or C. gatti	–	In CM-IRIS major complications, such as CNS inflammation with increased intracranial pressure, corticosteroids (0.5–1.0 mg/kg per day of prednisone equivalent) should be administered and possibly dexamethasone at higher doses for severe CNS signs and symptoms, with a concomitant antifungal regimen.	Meta analysis
Slom et al., 2002	A. cantonensis	12	Repeated lumbar punctures and corticosteroid therapy led to improvement of severe headaches and intracranial pressure decrease.	Case series
Maretic et al., 2009	A. cantonensis	11	Data supports use of albendazole and mebendazole steroid treatment. Anthelmintic treatment administration not recommended without adjunctive steroid treatment.	Case series
Wang et al., 2012	A. cantonensis	–	Small outbreak data supports corticosteroids treatment in combination with anthelmintics	Meta analysis
Pereira-Chioccola et al., 2009	Toxoplasma gondii	–	Cases of diffuse encephalitis and expansive lesions with a mass effect in the brain are recommended adjunctive corticosteroid therapy.	Meta analysis
Sonneville et al., 2012	Toxoplasma gondii	100	Analyzed patients with HIV and the outcome of adjunctive steroid therapy. With the use of pyrimethamine-sulfadiazine treatment, adjunctive steroids to treat cerebral edema associated with focal lesions are safe but not associated with better neurologic outcomes.	Observational Study
Singhi et al., 2004	Taenia solium	133	Disappearance of lesions at 3-month follow up higher (62.9%) in corticosteroid treatment with albendazole group compared to albendazole treatment alone (52.6%). Children in the corticosteroid group had significantly higher seizure recurrence while on AEDs.	RCT
Kishore and Misra, 2007	Taenia solium	100	Higher resolution in group that received prednisone alone (68.1%) compared to treatment with antiepileptic monotherapy (60.9%) (p<0.05)	RCT
White et al., 2018	Taenia solium	–	Guidelines for the treatment of Neurocysticercosis in America. Corticosteroids should be used in viable parenchymal NCC for reduction in seizure frequency.Corticosteroids should be given with antiparasitic with single enhancing lesion NCC. Corticosteroids should be used, while avoiding antiparasitic treatment with cysticercal encephalitis (with diffuse cerebral edema). Corticosteroids should not be routinely used for calcified parenchymal NCC with or without perilesional edema due to the development of calcifications with perilesional edema in some cases	Meta analysis