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  • Updated 02.09.2024
  • Released 06.13.2005
  • Expires For CME 02.09.2027

Candidiasis of the nervous system



Candida became a common central nervous system pathogen in the 1960s with the advent of chemotherapeutic agents, glucocorticoids, and injection drug use. Although Candida albicans continues to be the most common pathogen overall, there has been an increasing trend towards nonalbicans species in the last 10 years. Meningitis is the most common form of central nervous system (CNS) infection. The clinical symptoms are highly variable. Careful examination of the ocular fundus and the skin may provide clues to suspect Candida infection. Premature infants requiring neurosurgical interventions are at increased risk of both disseminated and CNS candidiasis. In some specific clinical situations, such as bone marrow transplant recipients or severe burn patients, Candida is the leading cause of CNS infection. Mortality is almost 90% when disseminated candidiasis involves central nervous system. Diagnosis is often made from biopsy specimens or culture. Candida meningitis responds best to intravenous amphotericin B and oral flucytosine. The prevalence of multidrug-resistant Candida auris has increased among patients with coronavirus disease 2019 (COVID-19). On World Health Organization’s first fungal pathogen priority list published in late 2022, Candida albicans and C auris are among the pathogens of critical importance, which will enhance much needed public awareness, innovation, and research in this direction.

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, primary immunodeficiency disorders, 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 two patients. In 1861, Zenker discovered a Candida-like organism in brain lesions. A brain abscess caused by Candida species was initially reported in 1895 (33). 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 (55).

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