1/6. Cerebral granuloma and meningitis caused by candida albicans: useful monitoring of mannan antigen in cerebrospinal fluid.The authors report the case of a previously healthy patient who had recurrent cerebral granulomas and meningitis caused by candida albicans 15 years after the first onset. A combination of external drainage of cerebrospinal fluid (CSF) and intraventricular and intravenous chemotherapy with antifungal agents resulted in a favorable outcome. Investigation of this patient revealed no immunological dysfunction, lymphoproliferative disorder, or candidicidal defect of peripheral blood leukocytes. Sequential measurement of Candida mannan antigen in CSF was useful for establishing the early diagnosis of cerebral candidiasis and for judging the effect of our antifungal chemotherapy. In determining the surgical indications and timing of placement of a ventriculoperitoneal or ventriculoatrial shunt for meningitis subsequent to hydrocephalus after candidal infection, it is better to confirm normal concentrations of the mannan antigen in the CSF repeatedly for more than a week and to determine that cultures of the CSF are negative for candida albicans.- - - - - - - - - - ranking = 1keywords = candida (Clic here for more details about this article) |
2/6. Analysis of the antibody response developing in an infant with candida albicans meningitis.A case of meningitis due to candida albicans in a neonate is described. This is the first report of an immunoblot analysis of both serial samples of serum and cerebrospinal fluid in relation to C. albicans antigens. The western blot technique demonstrated that the mother had IgM antibody against five candidal antigens, including one of molecular weight 47 kDaltons, but only a small amount of IgG antibody against two antigens of molecular weight 104 kDaltons and 60 kDaltons respectively. The baby produced IgM antibody and then IgG antibody against an antigen of 47 kDaltons molecular weight, and this was associated with recovery.- - - - - - - - - - ranking = 1keywords = candida (Clic here for more details about this article) |
3/6. meningitis and facial paresis. Implications for cochlear implantation.Most postlingually deafened individuals receive auditory sensations with a cochlear implant. We describe a postmeningitic patient with bilateral facial paresis who failed to be stimulated with a multichannel device. In light of the facial dysfunction, primary auditory nerve damage by meningitis is postulated as the cause of implant failure. Preoperation electrical stimulation of the cochlea using an alternating current signal is recommended as a means of assessing cochlear implant candidacy.- - - - - - - - - - ranking = 1keywords = candida (Clic here for more details about this article) |
4/6. candida tropicalis meningitis: a case report.A 54-year-old man presented with candida tropicalis meningitis after exploration of the mastoid. He responded well to the combined intravenous administration of amphotericin b and 5 fluorocytosine. But 5 fluorocytosine had to be withdrawn when the candida proved to be resistant to this antifungal agent. However, the patient made an uneventful recovery. This seems to be the first report of a candida tropicalis meningitis in an otherwise healthy adult patient in this country.- - - - - - - - - - ranking = 3keywords = candida (Clic here for more details about this article) |
5/6. MRI and clinical decisions in cochlear implantation.High-resolution computed tomography (HRCT) is the standard imaging technique used in cochlear implantation. However, cochlear and retrocochlear soft-tissue abnormalities may not be detected with HRCT alone. To determine whether magnetic resonance imaging (MRI) provides clinically significant information in addition to HRCT in the evaluation of candidates for cochlear implants, we performed a prospective study of 13 consecutive patients with cochlear implant patients receiving preoperative, high-resolution fast spin-echo T2-weighted MRI scans of the temporal bone. MRI identified unanticipated cochlear fibrosis in one patient, vestibular schwannoma in one patient, patency in the second turn of the cochlea in a patient with labyrinthitis ossificans, and disproved cochlear fibrosis suspected on HRCT imaging in one patient. These findings were significant for clinical decisions regarding candidacy for surgery, side selection for surgery, and surgical technique in cochlear implantation. Our experience suggests a high-resolution T2-weighted MRI of the temporal bone should be used preoperatively in addition to HRCT before cochlear implantation.- - - - - - - - - - ranking = 2keywords = candida (Clic here for more details about this article) |
6/6. Hypertrophic cranial pachymeningitis in a patient with aplastic anemia.We report on a 13-year old girl with severe aplastic anemia and hypertrophic cranial pachymeningitis. She was admitted to our hospital with severe headache and vomiting. A computerized tomographic (CT) scan of the brain on the third day of symptoms showed a hyperdense area in the tentorial region. Magnetic resonance imaging (MRI) showed iso-intensity in the same tentorial region in T1- and T2-weighted images, and gadolinium enhancement of this region suggested a thickened dura mater. Initially, a diagnosis of subdural or subarachnoid hemorrhage was made. Since her platelet count was low (3000/microl) making the patient a poor-risk candidate for surgery, and the area was limited to the dura mater, conservative therapy, including glycerol administration and platelet transfusion, was carried out. Despite clinical improvement 10 days after admission without specific therapy, the iso-intense region on the left side of the tentorial region remained unchanged on MRI. On the other hand, the iso-intense area on the right side of the tentorial region became hyperdense on T1-weighted MRI images and was also enhanced by gadolinium. cerebrospinal fluid findings were normal except for slightly elevated protein at 62 mg/dl. A diagnosis of hypertrophic cranial pachymeningitis of the tentorial dura mater with hemorrhage on the right side was made. Although hypertrophic cranial pachymeningitis is a rare disease, it must be considered in the differential diagnosis of severe headache in a case of aplastic anemia.- - - - - - - - - - ranking = 1keywords = candida (Clic here for more details about this article) |