Candida infections of the central nervous system
- 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
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 [1,2]. The abscesses are usually small microabscesses, multiple, and associated with disseminated infection in immunocompromised hosts .
Candida meningitis can occur as a manifestation of disseminated candidiasis, which most often occurs in premature neonates [4-6], in the presence of ventricular drainage devices [7-10], and as isolated chronic meningitis [3,11,12]. In addition to hematogenous spread [4,5,13], Candida can enter the CNS at the time of craniotomy  or through a ventricular shunt [7-10].
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 are 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 and invasive candidiasis in children: Clinical manifestations and diagnosis" and "Candidemia and invasive candidiasis in children: Management" and "Epidemiology and risk factors for Candida infection in neonates" and "Treatment of Candida infection in neonates".)
As with Candida infections at most other sites, patients who develop central nervous system infections are usually immunocompromised . In addition to occurring in premature neonates and after neurosurgery [4,5,7-10,14], the risk is also in increased HIV-infected patients  and in those with leukemia . (See "Epidemiology and pathogenesis of candidemia in adults", section on 'Risk factors' and "Epidemiology and risk factors for Candida infection in neonates" and "Candidemia and invasive candidiasis in children: Clinical manifestations and diagnosis", section on 'Risk factors'.)
Candida central nervous system (CNS) infections are almost always due to C. albicans [3,4] but can occur with other species, such as C. parapsilosis and C. tropicalis [9,13]. C. glabrata is a rare cause of CNS infection [4,9]. (See "Epidemiology and pathogenesis of candidemia in adults", section on 'Epidemiology'.)
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- CLINICAL FEATURES
- Premature neonates
- CNS shunts and other devices
- Chronic meningitis
- CSF analysis
- Antifungal therapy
- - Duration
- Removal of CNS devices
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS
- Epidemiology and clinical features