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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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Follow-up brain magnetic resonance imaging(MRI). After antifungal treatment with fluconazole for 49 weeks, showing a complete resolution of brain abscesses with global atrophy. (A’: T1 post gadolinium; B’: T2 flair).
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Fig3: Follow-up brain magnetic resonance imaging(MRI). After antifungal treatment with fluconazole for 49 weeks, showing a complete resolution of brain abscesses with global atrophy. (A’: T1 post gadolinium; B’: T2 flair).

Mentions: Antimicrobial therapy was maintained with fluconazole and meropenem was withdrawn. The patient was extubated on day 12 and sedation was weaned off with recovery of his conscience level. Brain MRI was repeated three weeks after and showed radiological improvement with reduction of surrounding oedema but with persistent enhancing lesions. The patient recovered without neurologic disability and had a good radiological response on subsequent MRI. He was discharged home after two months of hospitalization under anti-fungal therapy consisting of oral fluconazole 400 mg bid and anticonvulsant drugs. He did well on outpatient follow-up, without new episodes of seizures and neurologic sequelae. Fluconazole therapy was maintained for 49 weeks when a complete resolution of brain abscesses was seen on follow-up brain MRI (Figure 3).Figure 3


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)

Follow-up brain magnetic resonance imaging(MRI). After antifungal treatment with fluconazole for 49 weeks, showing a complete resolution of brain abscesses with global atrophy. (A’: T1 post gadolinium; B’: T2 flair).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Follow-up brain magnetic resonance imaging(MRI). After antifungal treatment with fluconazole for 49 weeks, showing a complete resolution of brain abscesses with global atrophy. (A’: T1 post gadolinium; B’: T2 flair).
Mentions: Antimicrobial therapy was maintained with fluconazole and meropenem was withdrawn. The patient was extubated on day 12 and sedation was weaned off with recovery of his conscience level. Brain MRI was repeated three weeks after and showed radiological improvement with reduction of surrounding oedema but with persistent enhancing lesions. The patient recovered without neurologic disability and had a good radiological response on subsequent MRI. He was discharged home after two months of hospitalization under anti-fungal therapy consisting of oral fluconazole 400 mg bid and anticonvulsant drugs. He did well on outpatient follow-up, without new episodes of seizures and neurologic sequelae. Fluconazole therapy was maintained for 49 weeks when a complete resolution of brain abscesses was seen on follow-up brain MRI (Figure 3).Figure 3

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