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Candida albicans brain abscesses in an injection drug user patient: a case report.

Neves N, Santos L, Reis C, Sarmento A - BMC Res Notes (2014)

Bottom Line: Its incidence, however, is rising as a result of the increasing use of immunosuppressive agents, corticosteroids and broad-spectrum antimicrobial therapy.Brain imaging revealed multiple ring-enhancing lesions with oedema and mass effect.This case illustrates the importance of early recognition of predisposing factors and multidisciplinary approach in timely therapeutic intervention, in order to prevent neurologic sequelae and improve the outcome of the patients with this severe and challenging form of central nervous system infection.

View Article: PubMed Central - PubMed

Affiliation: Infectious Diseases Department, Centro Hospitalar São João and Faculty of Medicine of Porto University, Porto, Portugal. nelianeves@gmail.com.

ABSTRACT

Background: Fungal brain abscess is an uncommon disease, mostly associated with immunocompromised states and poorly controlled diabetes. Its incidence, however, is rising as a result of the increasing use of immunosuppressive agents, corticosteroids and broad-spectrum antimicrobial therapy. Candida species have emerged as the most prevalent etiologic agents of brain abscesses in autopsy studies.

Case presentation: A 46-year-old male with a history of injection drug abuse, chronic hepatitis C and diabetes mellitus presented to the Emergency Department of our hospital following a generalized tonic-clonic seizure without recovery of mental status. On admission, the patient was in coma, febrile, with severe acidemia with respiratory and metabolic acidosis, requiring invasive mechanical ventilation. Brain imaging revealed multiple ring-enhancing lesions with oedema and mass effect. Microbiologic studies, including cerebrospinal fluid, blood, sputum and urine cultures, were all negative. A stereotactic brain biopsy was performed and culture of brain specimens revealed Candida albicans. The patient was successfully treated with fluconazole therapy for 48 weeks presenting a good clinical response and a complete radiological resolution of brain abscesses.

Conclusion: Despite advances in diagnostic and therapeutic procedures, fungal brain abscess remains a life-threatening disease with a poor outcome. Successful treatment requires an early diagnosis and usually a combined medical and surgical approach. A long-term antibiotic regimen is a cornerstone of fungal brain abscesses treatment, with the endpoint determined by clinical and neuroimaging response. The authors report an uncommon case of successfully treated Candida albicans brain abscesses with anti-fungal therapy consisting of fluconazole alone. This case illustrates the importance of early recognition of predisposing factors and multidisciplinary approach in timely therapeutic intervention, in order to prevent neurologic sequelae and improve the outcome of the patients with this severe and challenging form of central nervous system infection.

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Related in: MedlinePlus

Head computed tomography(CT)scan on admission. Showed heterogeneous densities involving basal ganglia particularly in the left side and right temporo-parietal region, with mass effect. Post contrast images depicted ring-enhancing lesions.
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Fig1: Head computed tomography(CT)scan on admission. Showed heterogeneous densities involving basal ganglia particularly in the left side and right temporo-parietal region, with mass effect. Post contrast images depicted ring-enhancing lesions.

Mentions: Head computed tomography (CT) scan showed multiple contrast ring enhancing lesions, in left basal ganglia and right subcortical temporo-parietal region, with oedema and mass effect (Figure 1). A lumbar puncture was performed and analysis of the CSF showed normal levels of white-cell count, proteins and glucose (2 cels/uL, 0.10 g/L and 0.55 g/L, respectively); CSF was sent for culture, molecular tests and pathological examination. Electroencephalogram (EEG) showed non-specific encephalopathy with epileptiform activity in right frontal region. Intravenous (IV) meropenem 2 g tid was started empirically on ER for suspected bacterial cerebral abscesses, and adjunctive therapy with mannitol and dexamethasone was added. The patient was transferred to the Infectious Diseases Intensive Care Unit (ICU) with these focal brain lesions with mass effect of unknown etiology.Figure 1


Candida albicans brain abscesses in an injection drug user patient: a case report.

Neves N, Santos L, Reis C, Sarmento A - BMC Res Notes (2014)

Head computed tomography(CT)scan on admission. Showed heterogeneous densities involving basal ganglia particularly in the left side and right temporo-parietal region, with mass effect. Post contrast images depicted ring-enhancing lesions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4255923&req=5

Fig1: Head computed tomography(CT)scan on admission. Showed heterogeneous densities involving basal ganglia particularly in the left side and right temporo-parietal region, with mass effect. Post contrast images depicted ring-enhancing lesions.
Mentions: Head computed tomography (CT) scan showed multiple contrast ring enhancing lesions, in left basal ganglia and right subcortical temporo-parietal region, with oedema and mass effect (Figure 1). A lumbar puncture was performed and analysis of the CSF showed normal levels of white-cell count, proteins and glucose (2 cels/uL, 0.10 g/L and 0.55 g/L, respectively); CSF was sent for culture, molecular tests and pathological examination. Electroencephalogram (EEG) showed non-specific encephalopathy with epileptiform activity in right frontal region. Intravenous (IV) meropenem 2 g tid was started empirically on ER for suspected bacterial cerebral abscesses, and adjunctive therapy with mannitol and dexamethasone was added. The patient was transferred to the Infectious Diseases Intensive Care Unit (ICU) with these focal brain lesions with mass effect of unknown etiology.Figure 1

Bottom Line: Its incidence, however, is rising as a result of the increasing use of immunosuppressive agents, corticosteroids and broad-spectrum antimicrobial therapy.Brain imaging revealed multiple ring-enhancing lesions with oedema and mass effect.This case illustrates the importance of early recognition of predisposing factors and multidisciplinary approach in timely therapeutic intervention, in order to prevent neurologic sequelae and improve the outcome of the patients with this severe and challenging form of central nervous system infection.

View Article: PubMed Central - PubMed

Affiliation: Infectious Diseases Department, Centro Hospitalar São João and Faculty of Medicine of Porto University, Porto, Portugal. nelianeves@gmail.com.

ABSTRACT

Background: Fungal brain abscess is an uncommon disease, mostly associated with immunocompromised states and poorly controlled diabetes. Its incidence, however, is rising as a result of the increasing use of immunosuppressive agents, corticosteroids and broad-spectrum antimicrobial therapy. Candida species have emerged as the most prevalent etiologic agents of brain abscesses in autopsy studies.

Case presentation: A 46-year-old male with a history of injection drug abuse, chronic hepatitis C and diabetes mellitus presented to the Emergency Department of our hospital following a generalized tonic-clonic seizure without recovery of mental status. On admission, the patient was in coma, febrile, with severe acidemia with respiratory and metabolic acidosis, requiring invasive mechanical ventilation. Brain imaging revealed multiple ring-enhancing lesions with oedema and mass effect. Microbiologic studies, including cerebrospinal fluid, blood, sputum and urine cultures, were all negative. A stereotactic brain biopsy was performed and culture of brain specimens revealed Candida albicans. The patient was successfully treated with fluconazole therapy for 48 weeks presenting a good clinical response and a complete radiological resolution of brain abscesses.

Conclusion: Despite advances in diagnostic and therapeutic procedures, fungal brain abscess remains a life-threatening disease with a poor outcome. Successful treatment requires an early diagnosis and usually a combined medical and surgical approach. A long-term antibiotic regimen is a cornerstone of fungal brain abscesses treatment, with the endpoint determined by clinical and neuroimaging response. The authors report an uncommon case of successfully treated Candida albicans brain abscesses with anti-fungal therapy consisting of fluconazole alone. This case illustrates the importance of early recognition of predisposing factors and multidisciplinary approach in timely therapeutic intervention, in order to prevent neurologic sequelae and improve the outcome of the patients with this severe and challenging form of central nervous system infection.

Show MeSH
Related in: MedlinePlus