Human cerebral candidosis — A postmortem evaluation of 19 patients

Abstract

Candidosis is the most common portmortem cerebral mycosis, yet is rarely appreciated clinically. From 8975 complete autopsies, 41 patients were identified with tissue verified deep candidosis. Nineteen of them (46 per cent) had cerebral candidal infections. There were eight males and 11 females, and 15 whites and four blacks. The ages varied from 17 days to 82 years, with a mean age of 40 years. Cancer was observed in four (21 per cent). All 19 individuals had proven or suspected gram negative sepsis and had been treated with appropriate antibiotic therapy. Other predisposing factors included major surgery (63 per cent), steroid therapy (53 per cent), and deep venous lines (42 per cent). Candida species was identified outside the brain in every patient and included the kidneys (90 per cent), heart (80 per cent), and other organs. Portals of entry appeared to be the gastrointestinal tract, deep venous lines, or both. In this autopsy population, candidosis occurred only in compromised patients and produced intracerebral microabscesses and noncaseating granulomas without diffuse leptomeningitis. Cerebral lesions occurred late in the disease, and were complicated by cardiac and renal candidosis, which contributed to the patient's death. With an increased awareness of the appropriate clinical setting, this iatrogenic mycosis can be handled properly and prevented from jeopardizing the patient.