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Human cerebral candidosis--a postmortem evaluation of 19 patients
Abstract:
Candidosis is the most common postmortem cerebral mycosis, yet is rarely appreciated clinically. From 8975 complete autopsies, 41 patients were identified with tissue verified deep candidosis. Nineteen of them (46 per cent) had cerebral candidal infections. There were eight males and 11 females, and 15 whites and four blacks. The age varied from 17 days to 82 years, with a mean age of 40 years. Cancer was observed in four (21 per cent). All 19 individuals had proven or suspected gram negative sepsis and had been treated with appropriate antibiotic therapy. Other predisposing factors included major surgery (63 per cent), steroid therapy (53 per cent), and deep venous lines (42 percent). Candida species was identified outside the brain in every patient and included the kidneys (90 per cent), heart (80 per cent), and other organs. Portals of entry appeared to be the gastrointestinal tract, deep venous lines, or both. In this autopsy population, candidosis occurred only in compromised patients and produced intracerebral microabscesses and noncaseating granulomas without diffuse leptomeningitis. Cerebral lesions occurred late in the disease, and were complicated by cardiac and renal candidosis, which contributed to the patient's death. With an increased awareness of the appropriate clinical setting, this iatrogenic mycosis can be handled properly and prevented from jeopardizing the patient.
Insights
Deep candidosis, a fungal infection, commonly affects the brain postmortem, particularly in compromised patients. Early recognition of risk factors like sepsis and surgery is crucial for clinical management and prevention.
Area of Science:
- Medical Mycology
- Neuropathology
- Infectious Diseases
Background:
- Candidosis is the most frequent postmortem cerebral mycosis, often overlooked clinically.
- Deep candidosis, confirmed by tissue, was found in 41 of 8975 autopsies.
Purpose of the Study:
- To investigate the incidence and characteristics of cerebral candidosis in autopsy cases.
- To identify predisposing factors and clinical settings associated with deep candidosis.
Main Methods:
- Retrospective analysis of 8975 complete autopsies.
- Identification and characterization of deep candidosis, including cerebral involvement.
- Correlation of candidosis with patient demographics, clinical history, and predisposing factors.
Main Results:
- Cerebral candidal infections were present in 19 patients (46% of deep candidosis cases).
- Predisposing factors included gram-negative sepsis (100%), major surgery (63%), steroid therapy (53%), and deep venous lines (42%).
- Candida species were found in kidneys (90%) and heart (80%), with gastrointestinal tract and venous lines as likely entry points.
Conclusions:
- Cerebral candidosis occurs in compromised patients, presenting as microabscesses and granulomas, not diffuse meningitis.
- Cerebral lesions appear late, often complicated by other organ candidosis, contributing to mortality.
- Increased clinical awareness of risk factors can improve management and prevention of this iatrogenic mycosis.