Candida infections of the central nervous system

Author

Carol A Kauffman, MD

Carol A Kauffman, MD

• Section Editor — Fungal Infections
• Professor of Internal Medicine
• University of Michigan Medical School
• Veterans Affairs Ann Arbor Healthcare System

Section Editor

Kieren A Marr, MD

Kieren A Marr, MD

• Section Editor — Compromised Host Infections
• Section Editor — Fungal Infections
• Professor of Medicine and Oncology
• Johns Hopkins University School of Medicine

Deputy Editor

Anna R Thorner, MD

Anna R Thorner, MD

• Deputy Editor — Infectious Diseases
• Assistant Clinical Professor of Medicine
• Harvard Medical School

INTRODUCTION

Candida infections of the central nervous system (CNS) most often involve the meninges. However, intracranial abscesses can occur either as an isolated phenomenon or associated with meningitis [1]. The abscesses are usually small microabscesses, multiple, and associated with disseminated infection in immunocompromised hosts [2].
Candida meningitis can occur as a manifestation of disseminated candidiasis, which most often occurs in premature neonates [3,4], in the presence of ventricular drainage devices [5-8], and as isolated chronic meningitis [2,9,10]. In addition to hematogenous spread [3,4,11], Candida can enter the CNS at the time of craniotomy [5] or through a ventricular shunt [5-8].
The clinical features, diagnosis, and treatment of Candida meningitis will be reviewed here. An overview of Candida infections is presented separately. Candidemia and invasive candidiasis also discussed separately. (See "Overview of Candida infections" and "Epidemiology and pathogenesis of candidemia in adults" and "Clinical manifestations and diagnosis of candidemia and invasive candidiasis in adults" and "Treatment of candidemia and invasive candidiasis in adults" and "Candidemia in children: Clinical features and diagnosis" and "Candidemia in children: Treatment" and "Epidemiology and risk factors for Candida infection in neonates" and "Treatment of Candida infection in neonates".)

EPIDEMIOLOGY

As with Candida infections at most other sites, patients who develop central nervous system infections are usually immunosuppressed [2]. In addition to occurring in premature neonates and after neurosurgery [3-8], the risk is also in increased HIV-infected patients [10] and in those with leukemia [11]. (See "Epidemiology and pathogenesis of candidemia in adults", section on 'Risk factors' and "Epidemiology and risk factors for Candida infection in neonates" and "Candidemia in children: Clinical features and diagnosis", section on 'Risk factors'.)

MICROBIOLOGY

Candida central nervous system (CNS) infections are almost always due to C. albicans [2,3] but can occur with other species, such as C. parapsilosis and C. tropicalis [7,11]. C. glabrata is a rare cause of CNS infection [3,7]. (See "Epidemiology and pathogenesis of candidemia in adults", section on 'Epidemiology'.)

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Literature review current through: Mar 2015. | This topic last updated: Oct 14, 2014.

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References

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