Though
candidiasis is the most frequent
invasive fungal infection, Candida spp. central nervous system (
CNS) infections are rare but severe. To further describe clinico-patho-radiological presentations of this entity, we report a retrospective study from January 2005 to December 2018 including patients aged ≥ 28 days with proven or probable CNS
candidiasis in France. Twenty-four patients were included. Seventeen patients (70%) had CNS localization secondary to disseminated
candidiasis (10 with
hematologic malignancies [HM]; the seven other patients had
infective endocarditis [IE]). Among patients with HM, seven previously had lumbar puncture for intrathecal
chemotherapy, the three others had IE. Among patients with disseminated
infection, magnetic resonance imaging (MRI) evidenced
meningitis (17%), micro-
abscesses (58%), or vascular complications (67%). Seven patients (30%) had isolated CNS involvement related to neurosurgery (n = 2),
CARD9 deficiency (n = 2), intravenous drug use,
diabetes mellitus, or no identified predisposing condition (n = 1 each). All evaluated patients with isolated CNS involvement had
meningitis on cerebrospinal fluid (CSF) and
intracranial hypertension. For the latter patients, MRI evidenced
meningitis (71%) or
abscesses (57%). Among all patients, cerebrospinal fluid (CSF) culture grew Candida spp. in 31% of cases. CSF βDGlucan or
mannan Ag were positive in respectively 86% and 80% of cases. Mortality attributed to CNS
candidiasis was 42%: 53% in case of disseminated
infection (70% for HM) and 14% in case of localized
infection. CNS
candidiasis are isolated or occur during disseminated
infection in patients with HM and lumbar puncture for intrathecal
chemotherapy or during IE. Clinical, radiological finding and outcome highly vary according to CNS localized versus disseminated
candidiasis.
LAY SUMMARY: Candida is a yeast and is the most common cause of
fungal infections worldwide. Candida central nervous system (
CNS) infections are rare, severe, and poorly described. We report a retrospective study from January 2005 to December 2018 including patients aged ≥ 28 days with proven or probable CNS
candidiasis in France. Twenty-four patients were included (14 men, median age 51 years). Seventeen patients had CNS localization secondary to disseminated
candidiasis from blood to CNS (10 with
hematologic malignancies [HM], the seven other patients had
infective endocarditis [IE]). Seven patients had isolated CNS involvement related to neurosurgery (n = 2),
CARD9 deficiency (n = 2), intravenous drug use (n = 1),
diabetes mellitus (n = 1), or no identified risk factor (n = 1).During Candida
CNS infections, brain lesions were
meningitis abscesses or vascular complications. Cerebrospinal fluid (CSF) culture grew Candida spp. in 31% of cases. Forty-two percent of patients died from
infection: 53% in case of disseminated
infection (70% for HM) and 14% in case of localized
infection.