Dr. Raibagkar of the Lahey Hospital & Medical Center has no relevant financial relationship to disclose.)
Dr. Marra of the University of Washington School of Medicine has no relevant financial relationships to disclose.)
Candida became a common central nervous system pathogen in the 1960s with the advent of chemotherapeutic agents, glucocorticoids, and intravenous drugs; candidiasis is now responsible for more than 90% of all clinically significant fungal infections. Nearly 50% of the patients dying from invasive candidiasis have CNS involvement (Panackal 2015). Meningitis is the most common form of CNS infection. The clinical symptoms are highly variable. Careful examination of the ocular fundus and the skin provides clues to suspect candida infection. There is an increased incidence of both disseminated and CNS candidiasis in newborns, especially premature infants. In some specific clinical situations, such as bone marrow transplant recipients or severe burn patients, Candida is the leading cause of CNS infection. Diagnosis is often made from biopsy specimens or culture. Candida meningitis responds best to intravenous amphotericin B and oral flucytosine.
• CNS candidiasis is a leading cause of mortality among invasive candidiasis infections.
• Neonates, patients with neurosurgical intervention, and immunosuppressed patients, including those with neutropenia, diabetes, extensive wounds, hematologic malignancy, people living with HIV (PLWH), organ transplant recipients, and intravenous drug users are susceptible to disseminated infection and, therefore, CNS invasion.
Historical note and terminology
The history of candidiasis dates to the 4th century BC when Hippocrates described oral aphtha (thrush) in 2 patients. In 1861, Zenker discovered a Candida-like organism in brain lesions. A brain abscess caused by Candida species was initially reported in 1895 (Kwon-Chung and Bennett 1992). In 1933 Smith and Sano identified the first case of Candida meningitis, but it was not until 1943 that Candida was successfully cultured from a cerebral lesion. Candida remained a relatively uncommon CNS pathogen until the 1960s when use of chemotherapeutic agents, glucocorticoids, and intravenous heroin rendered increasing numbers of patients susceptible to Candida infections (Scheld et al 2004).
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