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Candidosis: the most common postmortem cerebral mycosis in an endemic fungal area
Abstract:
To determine the recent postmortem character of cerebral mycoses, 1,752 consecutive complete autopsies done in the endemic fungal area of central Kentucky from 1964 through 1973 were reviewed. Fourteen patients (0.8%) had histologically confirmed fungal infections in the brain. The most prevalent fungus was Candida spp. which was observed in six patients. Cryptococcosis was recognized in three patients; histoplasmosis in two; zygomycosis in two; and blastomycosis in one. In every patient these fungi were also seen in tissues outside the central nervous system and were identified microbiologically in nine. Unlike the pathogenic yeasts, Candida spp. and the zygomycetes produced intracerebral lesions without any significant meningeal reactions. Cerebral candidosis was recognized only at autopsy in patients compromised by previous multiple antibiotic therapy for gram-negative infections. On the other hand, immunosuppression was associated more commonly with the non-candidal fungal infections. An experimental model for systemic candidosis in adult Sprague-Dawley rats likewise demonstrated its difficult antemorten recognition even with cerebral lesions. Although clinical consequences from candidemia seem often inapparent, the associated intracerebral lesions may further compromise the altered host. Their frequency and significance remain to be elucidated.
Insights
Fungal brain infections are rare postmortem findings, with Candida species being the most common. These infections often occur in compromised patients and may go unrecognized before death.
Area of Science:
- Neurology
- Mycology
- Pathology
Background:
- Cerebral mycoses, or fungal infections of the brain, can be challenging to diagnose antemortem.
- Understanding the postmortem characteristics of these infections is crucial for improving clinical recognition and patient outcomes.
Purpose of the Study:
- To investigate the prevalence and characteristics of recent postmortem cerebral mycoses.
- To identify the types of fungi causing cerebral infections and their association with host factors.
Main Methods:
- Review of 1,752 consecutive complete autopsies performed between 1964 and 1973 in endemic fungal areas.
- Histological confirmation of fungal infections in the brain and identification of causative fungal species.
- Correlation of fungal infections with host conditions such as antibiotic therapy and immunosuppression.
Main Results:
- Fourteen patients (0.8%) had histologically confirmed fungal brain infections.
- Candida spp. was the most prevalent (six patients), followed by Cryptococcosis (three), histoplasmosis (two), zygomycosis (two), and blastomycosis (one).
- Candida and zygomycetes caused intracerebral lesions without significant meningeal reactions, often in patients with prior antibiotic therapy; non-candidal infections were more associated with immunosuppression.
Conclusions:
- Cerebral fungal infections are infrequent but significant postmortem findings, particularly in immunocompromised or medically treated patients.
- Cerebral candidosis is often unrecognized antemortem, even in experimental models, highlighting diagnostic challenges.
- The frequency and clinical significance of intracerebral lesions in candidemia require further investigation to understand their impact on compromised hosts.