1/10. Refractory candidal meningitis in an immunocompromised patient cured by caspofungin.Candidal meningitis is a rare infectious disease that usually leads to substantial morbidity and mortality. We present a case of candidal meningitis refractory to systemic antifungal therapy (amphotericin b and fluconazole). A 63-year-old female with lymphoblastic lymphoma and myelodysplasia with leukemia transformation developed prolonged fever and headache on the seventh day following intrathecal prophylactic chemotherapy. A lumbar puncture showed neutrophilic pleocytosis, and a cerebrospinal fluid culture yielded candida albicans. The clinical course was complicated by brain edema, subarachnoid hemorrhage, and hydrocephalus. Parenteral therapy with amphotericin b alone or amphotericin b in combination with fluconazole or intrathecal administration of amphotericin b failed to eradicate C. albicans in the cerebrospinal fluid. After 7 days of caspofungin therapy, however, the cerebrospinal fluid became sterile and the patient gradually regained consciousness. She was discharged 1 month after completing 4 weeks of caspofungin therapy. There were two critical issues we thought to be relevant to the favorable outcome of this case. First, isolation of C. albicans was achieved by inoculating enriched liquid medium with cerebrospinal fluid. Second, there is a potential therapeutic benefit of caspofungin in treating a fungal infection of the central nervous system.- - - - - - - - - - ranking = 1keywords = candida (Clic here for more details about this article) |
2/10. Candida meningitis in a suspected immunosuppressive patient--a case report.meningitis due to fungal agents represents an AIDS-defining event and occurs typically with very low CD4 lymphocyte count. Candida meningitis is still a rare clinical condition, although it is becoming frequently reported in the background of immune suppressive states such as: drug addicts, cancer patients, organ transplant recipients and hiv/AIDS patients. In this report we highlight a case of candida meningitis, in a 25- year old female patient. She presented with vulva swelling, vaginal discharge and fever, with rapid progression to tonic-clonic convulsions and loss of consciousness. She fully recovered after treatment with fluconazole.- - - - - - - - - - ranking = 0.2keywords = candida (Clic here for more details about this article) |
3/10. amphotericin b in the treatment of candida meningitis in three neonates.candidiasis is an opportunistic infection and may result in significant morbidity and mortality in neonates. Cerebral candidiasis is rare and usually associated with systemic candidiasis. Information concerning the toxicity and efficacy of antifungal therapy for neonates is limited. In this report, we present three neonates with candidiasis. All of the patients were premature with low birth weights, and received antibiotic therapy for one to four weeks before the onset of candidiasis. candida albicans was isolated from cerebrospinal fluid cultures. amphotericin b was given administered at an initial dose of 0.25 mg/kg/day intravenously (IV) and increased to a dosage of 2 mg/kg/day, and therapy was continued for three to four weeks. A transient and mild elevation in hepatic enzyme concentration was observed in two patients, and transient thrombocytopenia occurred in all of them.- - - - - - - - - - ranking = 0.8keywords = candida (Clic here for more details about this article) |
4/10. Neonatal cerebral candidiasis: CT findings and clinical correlation.Lumbar puncture in a premature newborn undergoing therapy for sepsis revealed meningitis. Contrast-enhanced cranial tomography revealed multiple, homogeneously or ring-like enhanced lesions with peripheral edema. cerebrospinal fluid culture showed growth of candida. Significant clinical recovery after Amphotericin-B treatment was noted. Follow-up CT examination showed regression of the lesions. Five months later no pathology was reported except small calcified granulomas and an area of encephalomalacia.- - - - - - - - - - ranking = 0.2keywords = candida (Clic here for more details about this article) |
5/10. Chronic candidal meningitis: an uncommon manifestation of candidiasis.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.- - - - - - - - - - ranking = 1keywords = candida (Clic here for more details about this article) |
6/10. Case report: familial chronic mucocutaneous candidiasis complicated by deep candida infection.Chronic mucocutaneous candidiasis (CMC) is usually characterized by onset in childhood and is almost never complicated by deep fungal infection. The authors report two cases of fatal candida meningitis in patients who suffered from mild, adult-onset CMC. The pedigrees suggest an autosomal recessive disorder. In the index cases and in a symptomatic sibling, the immunologic work-up showed a specific cellular deficit as opposed to candida albicans, as is typical of other forms of CMC. Both families were of French Canadian descent and originated from eastern quebec. Three other cases of primary candida meningitis in patients of the same ethnic origin are also reported and reviewed. It is suggested that these cases may represent a variant of familial adult-onset CMC, in which there is a striking predisposition to deep infection.- - - - - - - - - - ranking = 1.2keywords = candida (Clic here for more details about this article) |
7/10. meningitis caused by Candida species: an emerging problem in neurosurgical patients.Three cases of candida meningitis were encountered in a 3-year period in our hospital; all occurred in neurosurgical patients. We describe these three cases and review the 15 cases of neurosurgery-related candida meningitis previously reported in the English-language literature. Data regarding these 18 patients formed the basis for our review. Most patients with candida meningitis had recently received antibacterial agents, and it is notable that 50% of patients suffered from antecedent bacterial meningitis. The CSF analysis revealed neutrophilic pleocytosis that was indistinguishable from that of bacterial meningitis. The overall mortality was 11%. Administration of amphotericin b combined with flucytosine appeared to be the best therapeutic approach for candida meningitis.- - - - - - - - - - ranking = 0.8keywords = candida (Clic here for more details about this article) |
8/10. Candidal meningitis in hiv-infected patients: analysis of 14 cases.Five cases of candidal meningitis in human immunodeficiency virus (hiv)-infected patients have been diagnosed in our hospital. This article describes these cases and reviews another nine previously reported in the literature. Most patients (71%) had at least one well-known predisposing factor for candidiasis. Median CD4 cell count was 135/mm3. headache and fever, in the absence of focal neurologic signs, were the predominant clinical features. The CSF analysis revealed mild pleocytosis and hypoglycorrachia, indistinguishable from those seen in tuberculous or cryptococcal meningitis. Twelve patients (92%) received amphotericin b for a median of 51 days, in combination with flucytosine in five cases. The overall mortality among treated patients was 31%. Although the risk of relapse of candidal meningitis is unknown, maintenance antifungal therapy was given to seven patients (63%), usually with fluconazole. Candida species must be kept in mind as a cause of chronic meningitis in hiv-infected patients who have a known predisposing factor.- - - - - - - - - - ranking = 0.4keywords = candida (Clic here for more details about this article) |
9/10. Vasculitic basilar artery thrombosis in chronic candida albicans meningitis.BACKGROUND: Cerebrovascular complications of meningitis have been most extensively documented in the setting of acute bacterial or chronic tuberculous meningitis. Involvement of major cerebral vessels is rare and basilar artery thrombosis has not been reported in fungal meningitis secondary to candida infection. methods: We describe the clinical course and neuropathological findings in a woman with chronic meningitis due to candida albicans. RESULTS: The diagnosis remained elusive antemortem despite analysis of 7 large volume CSF samples and examination of a meningeal and cortical biopsy. death followed extensive brainstem and temporo-occipital infarction secondary to basilar artery thrombosis. The basilar artery occlusion was secondary to an intense, granulomatous and necrotizing basal meningitis focally extending to the media and intima. CONCLUSIONS: This paroxysmal and devastating complication of untreated chronic candida meningitis reinforces that a trial of empirical therapy with both antituberculous and antifungal agents should be considered in most cases of chronic culture-negative lymphocytic meningitis.- - - - - - - - - - ranking = 0.4keywords = candida (Clic here for more details about this article) |
10/10. Candidal meningitis in hiv-infected patients: treatment with fluconazole.Although mucocutaneous candidiasis is a common occurrence in hiv-infected patients, candidal meningitis is uncommon. We report 3 cases of candidal meningitis in hiv-positive patients, all intravenous drug abusers, and we discuss the clinical course and outcome, the treatment with fluconazole and possible prophylaxis.- - - - - - - - - - ranking = 0.4keywords = candida (Clic here for more details about this article) |
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