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Chronic candidal meningitis: an uncommon manifestation of candidiasis
R A Voice1, S F Bradley, J A Sangeorzan
1Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
Abstract:
Chronic meningitis is an uncommon manifestation of candidiasis. We present the case of an elderly woman who had symptoms such as headache, malaise, and fever for 8 months and was found to have Candida albicans meningitis, and we review 17 similar cases. An underlying illness or risk factor for candidiasis was present in only 13 (72%) of the 18 patients. Headache, fever, and nuchal rigidity were the predominant clinical findings. Analysis of CSF showed either mononuclear or neutrophilic pleocytosis, an elevated protein level, and a decreased level of glucose. Only 17% of CSF smears were positive, and only 44% of initial CSF cultures yielded Candida species. In four cases, Candida species grew only after special techniques were used; in three cases, CSF cultures remained negative. The overall mortality associated with candidal meningitis was 53%, but among 12 patients who were treated and followed, the rate was 33%. In addition to acute meningitis seen with disseminated infection, Candida species can cause chronic meningitis that mimics tuberculosis and the more common fungal meningitides, such as cryptococcosis.
Insights
Chronic meningitis caused by Candida albicans is rare but serious, often mimicking other fungal infections. Early diagnosis and treatment are crucial for improving survival rates in affected patients.
Area of Science:
- Infectious Diseases
- Mycology
- Neurology
Background:
- Chronic meningitis is an infrequent manifestation of candidiasis.
- Candida albicans meningitis presents a diagnostic challenge, often mimicking other fungal meningitides like cryptococcosis or tuberculosis.
Observation:
- A case of an elderly woman with 8-month history of headache, malaise, and fever due to Candida albicans meningitis is presented.
- Review of 17 similar cases revealed that 72% of patients had an underlying illness or risk factor for candidiasis.
- Predominant clinical findings included headache, fever, and nuchal rigidity. Cerebrospinal fluid (CSF) analysis showed pleocytosis, elevated protein, and decreased glucose.
Findings:
- CSF smears were positive in only 17% of cases, and initial CSF cultures yielded Candida species in 44%.
- Special techniques were required for Candida species detection in 4 cases, and 3 cases had persistently negative CSF cultures.
- The overall mortality rate for candidal meningitis was 53%, decreasing to 33% in treated patients.
Implications:
- Candida species can cause chronic meningitis, posing a diagnostic challenge due to its mimicry of other meningitides.
- The low sensitivity of initial CSF analyses highlights the need for advanced diagnostic techniques.
- Improved treatment strategies are essential to reduce the high mortality associated with candidal meningitis.