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The emergence of candidosis. The dominant postmortem cerebral mycosis
Abstract:
Comparable human postmortem surveys in central Kentucky and southern Florida have demonstrated an altered pattern of cerebral mycoses due primarily to therapeutic manipulations. From both states 8,975 complete autopsies yielded 39 patients with histologically verified cerebral mycoses. The most common infection was candidosis (49%), characterized by intraparenchymal microabscesses without significant leptomeningitis in hospitalized patients compromised by antibiotic therapy for infection with gram-negative organisms. The remaining 20 patients with noncandidal cerebral mycoses included 9 (23%) with cryptococcosis, 5 (13%) with zygomycosis, 2 (5%) with aspergillosis, 2 (5%) with histoplasmosis, 1 (2.5%) with blastomycosis and 1 (2.5%) with curvulariosis. These compromised patients had leptomeningitis when infected with yeasts and cerebral infarcts with cerebritis when infected with hyphal fungi. In contrast to human cerebral candidosis, the non-candidal cerebral mycoses precipitated the patient's terminal hospitalization. These infections seemed to be contracted outside the hospital. Therapy for gram-negative bacterial infections has enabled Candida species to overtake Cryptococcus neoformans as the most common cause of postmortem cerebral mycosis.
Insights
Antibiotic therapy for gram-negative infections has shifted the leading cause of cerebral mycoses (fungal brain infections) from Cryptococcus neoformans to Candida species in postmortem surveys.
Area of Science:
- Medical Mycology
- Neuropathology
- Infectious Diseases
Background:
- Cerebral mycoses are fungal infections of the brain.
- Therapeutic interventions can alter the epidemiology of these infections.
- Postmortem studies provide insights into the prevalence and patterns of disease.
Purpose of the Study:
- To compare patterns of cerebral mycoses in human postmortem surveys.
- To investigate the impact of therapeutic manipulations on the prevalence of fungal brain infections.
- To identify the most common fungal agents causing cerebral mycoses.
Main Methods:
- Analysis of 8,975 complete human autopsies from Kentucky and Florida.
- Histological verification of cerebral mycoses in identified cases.
- Classification of fungal infections based on causative agents and clinical presentation.
Main Results:
- 39 cases of cerebral mycoses were identified.
- Candidosis was the most common infection (49%), often associated with antibiotic therapy for gram-negative infections.
- Non-candidal mycoses included cryptococcosis, zygomycosis, aspergillosis, histoplasmosis, blastomycosis, and curvulariosis.
- Candidosis presented as microabscesses without leptomeningitis in hospitalized patients.
- Non-candidal mycoses typically led to terminal hospitalization and were often contracted outside the hospital.
Conclusions:
- Therapy for gram-negative bacterial infections has led to Candida species becoming the most frequent cause of postmortem cerebral mycosis.
- Candida species now surpass Cryptococcus neoformans as the leading cause of fungal brain infections in this context.
- Different fungal types present distinct pathological patterns and clinical outcomes in compromised hosts.