Chronic candidal meningitis: an uncommon manifestation of candidiasis

Clin Infect Dis. 1994 Jul;19(1):60-6. doi: 10.1093/clinids/19.1.60.

Abstract

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.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Amphotericin B / therapeutic use
  • Candida albicans / isolation & purification
  • Candidiasis / cerebrospinal fluid
  • Candidiasis / diagnosis*
  • Candidiasis / drug therapy
  • Cerebrospinal Fluid Proteins / analysis
  • Female
  • Flucytosine / therapeutic use
  • Glucose / cerebrospinal fluid
  • Humans
  • Leukocyte Count
  • Meningitis, Fungal / cerebrospinal fluid
  • Meningitis, Fungal / diagnosis*
  • Meningitis, Fungal / drug therapy
  • Neutrophils

Substances

  • Cerebrospinal Fluid Proteins
  • Amphotericin B
  • Flucytosine
  • Glucose