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  • Updated 05.19.2021
  • Released 06.13.2005
  • Expires For CME 05.19.2024

Candidiasis of the nervous system

Introduction

Overview

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 (29). 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.

Key points

• 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 (19). 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 (40).

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