title: Chronic candidal meningitis: an uncommon manifestation of candidiasis.
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.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
authors.forename: R A
authors.initials: RA
authors.lastname: Voice
authors.forename: S F
authors.initials: SF
authors.lastname: Bradley
authors.forename: J A
authors.initials: JA
authors.lastname: Sangeorzan
authors.forename: C A
authors.initials: CA
authors.lastname: Kauffman
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D005260:Female; D005437:Flucytosine / Q000627:therapeutic use; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D007958:Leukocyte Count; D016921:Meningitis, Fungal / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy; D009504:Neutrophils
chemical_list: D002556:Cerebrospinal Fluid Proteins; D000666:Amphotericin B; D005437:Flucytosine; D005947:Glucose