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Central nervous system candidiasis beyond neonates: Lessons from a nationwide study
Hélène Chaussade1,2, Xavier Cazals3, Guillaume Desoubeaux4
1Université de Paris, Service de maladies infectieuses, hôpital Universitaire Necker-Enfants malades, Assistance Publique - Hôpitaux de Paris, IHU Imagine, Paris, France.
Medical Mycology
|June 25, 2020
Summary
Central nervous system (CNS) candidiasis, a rare but severe fungal infection, presents differently in localized versus disseminated cases. Outcomes vary significantly based on whether the infection is isolated or occurs with underlying conditions like hematologic malignancies.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Candida species are the most common cause of fungal infections globally.
- Central nervous system (CNS) candidiasis is a rare, severe, and under-documented clinical entity.
- This study investigates the clinical, pathological, and radiological features of CNS candidiasis.
Purpose of the Study:
- To describe the clinico-patho-radiological presentations of CNS candidiasis.
- To analyze outcomes in relation to localized versus disseminated forms of the infection.
Main Methods:
- Retrospective study of 24 patients with proven or probable CNS candidiasis in France (January 2005 - December 2018).
- Analysis of patient demographics, risk factors, clinical presentation, neuroimaging (MRI), cerebrospinal fluid (CSF) analysis, and outcomes.
- Categorization of cases into disseminated (secondary to bloodstream infection) and isolated CNS involvement.
Main Results:
- Seventeen patients (70%) had disseminated candidiasis, often linked to hematologic malignancies (HM) or infective endocarditis (IE).
- Among disseminated cases, MRI revealed meningitis (17%), micro-abscesses (58%), and vascular complications (67%).
- Seven patients (30%) had isolated CNS involvement, with meningitis and intracranial hypertension common; CSF culture positive in 31%, CSF βDGlucan/mannan Ag positive in 86%/80%.
Conclusions:
- CNS candidiasis can be isolated or occur during disseminated infection, particularly in patients with HM undergoing intrathecal chemotherapy or with IE.
- Clinical presentation, radiological findings, and outcomes differ significantly between localized and disseminated CNS candidiasis.
- Mortality was 42% overall, higher in disseminated (53%) versus localized (14%) infections, with HM patients facing the worst prognosis (70%).
