Candida albicans is an opportunistic pathogen that rarely causes disease in healthy individuals, but becomes pathogenic when host defense systems become compromised or when the organism can accumulate in large numbers, such as during prolonged antibiotic therapy. CNS disease usually results from hematogenous dissemination and, less frequently, through direct invasion [24]. An extracranial focus of candidi-asis is present in over 70% of patients with documented meningitis. Approximately 50% of patients with systemic candidiasis develop one of the following forms of CNS involvement:


Cerebral abscess.

Single or multiple granulomas.

The pathologic expression varies with age, meningitis being more common in children and neonates and micro-abscesses more prevalent in adults.

Candida produces a chronic, granulomatous meningitis, which, like cryptococcosis, can incite basal arachnoiditis with secondary cranial nerve dysfunction and/or hydrocephalus. Candida meningitis often occurs as a late complication of debilitating illness. Clinically, the typical clinical signs of meningitis may be present but, not infrequently, patients may be so ill and obtunded that they do not manifest the classic signs of meningitis. CNS involvement may also take the form of multiple miliary granulomas scattered throughout the brain, and presents clinically as a diffuse encephalopa-thy. Solitary or multiple cerebral abscesses can also occur. Because of the compromised host response, the capsule of a fungal abscess is often poorly developed and the abscess therefore less confined. The relative lack of capsule formation is often reflected on the CT image of a fungal

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