REVIEW

Surgery for Candida Brain Abscesses: a case report and review of the literature

Cirurgia para Abscesso Cerebral por Candida: um relato de caso e revisão da literatura

  • Leon Cleres Penido Pinheiro 1    Leon Cleres Penido Pinheiro 1
  • Renato Colenci 2    Renato Colenci 2
  • Mario Wolak Jr 2    Mario Wolak Jr 2
  • Cristiano do Val Serafim 2    Cristiano do Val Serafim 2
  • Pedro Tadao Hamamoto Filho 3    Pedro Tadao Hamamoto Filho 3
  • Marco Antonio Zanini 3    Marco Antonio Zanini 3
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Resumo

 Os abscessos cerebrais por Candida sp. são condições raras com altas taxas de mortalidade. Está associada à imunossupressão e deve ser considerada como diagnóstico diferencial em pacientes que não respondem aos tratamentos padrão para outras infecções do sistema nervoso central. Realizamos uma revisão da literatura sobre casos publicados de abscesso cerebral por cândida e comparamos casos cirúrgicos com não cirúrgicos. Relatos de casos ou séries de casos foram incluídos e os dados apresentados foram analisados. Um total de 29 pacientes foi incluído na análise. A média de internação foi de 37,7 dias para o grupo cirúrgico e 112,4 dias para o grupo não cirúrgico (p=0,001). A mortalidade geral foi de 13,8%, sendo 14,3% para o grupo cirúrgico e 13,3% para o grupo não cirúrgico (p=0,624). O abscesso cerebral por Candida sp. é uma condição rara, mas cada vez mais relevante. A ressecção cirúrgica pode aliviar os efeitos de massa local e permitir um diagnóstico etiológico definitivo. Mais estudos são necessários para investigar as diferenças entre tratamentos cirúrgicos e não cirúrgicos.

Palavras-chave

Palavras-chave: Abscesso cerebral; Infecção cerebral; Candida sp, Ressecção cirúrgica; Cirurgia para infecção cerebral

Abstract

 The Candida sp. cerebral abscess is a rare condition with high mortality rates. It is associated with immunosuppression and it should be considered as a differential diagnosis in patients who did not respond to standard treatments for other central nervous system infections. We performed a review of the literature on published cases of candida brain abscess and compared surgical to non-surgical cases. Case reports or case series were included and the data presented was analyzed. A total of 29 patients were included in the analysis. The average hospital stay was 37.7 days for the surgical group and 112.4 days for the non-surgical group (p=0.001). The overall mortality was 13.8%, with 14.3% for the surgical group and 13.3% for the non-surgical group (p=0.624). Candida sp. cerebral abscess is a rare but increasingly relevant condition. Surgical resection may alleviate local mass effects and enable a definitive etiologic diagnosis. More studies are needed to investigate the differences between surgical and non-surgical treatments.

Keywords

Keywords: Brain abscess; Brain infection; Candida sp; Surgical drainage; Surgery for brain infection

References

1. Fennelly AM, Slenker AK, Murphy LC, Moussouttas M, DeSimone JA. Candida cerebral abscesses: a case report and review of the literature. Med Mycol. 2013;51(7):779-84. http://dx.doi.org/10.3109/13693786.2 013.789566. PMid:23651179.

2. Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1-50. http:// dx.doi.org/10.1093/cid/civ933. PMid:26679628.

3. Antulov R, Dolic K, Fruehwald-Pallamar J, Miletic D, Thurnher MM. Differentiation of pyogenic and fungal brain abscesses with susceptibility-weighted MR sequences. Neuroradiology. 2014;56(11):937-45. http:// dx.doi.org/10.1007/s00234-014-1411-6. PMid:25085012.

4. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(5):503-35. http:// dx.doi.org/10.1086/596757. PMid:19191635.

5. Sanchez-Portocarrero J, Perez-Cecilia E, Corral O, Romero-Vivas J, Picazo JJ. The central nervous system and infection by Candida species. Diagn Microbiol Infect Dis. 2000;37(3):169-79. http://dx.doi. org/10.1016/S0732-8893(00)00140-1. PMid:10904190.

6. Jamjoom A, al-Abedeen Jamjoom Z, al-Hedaithy S, Jamali A, Naim Ur R, Malabarey T. Ventriculitis and hydrocephalus caused by Candida albicans successfully treated by antimycotic therapy and cerebrospinal fluid shunting. Br J Neurosurg. 1992;6(5):501-4. http:// dx.doi.org/10.3109/02688699208995043. PMid:1333229.

7. Neves N, Santos L, Reis C, Sarmento A. Candida albicans brain abscesses in an injection drug user patient: a case report. BMC Res Notes. 2014;7(1):837. http://dx.doi.org/10.1186/1756-0500-7-837. PMid:25421883.

8. Black JT. Cerebral candidiasis: case report of brain abscess secondary to Candida albicans, and review of literature. J Neurol Neurosurg Psychiatry. 1970;33(6):864-70. http://dx.doi.org/10.1136/jnnp.33.6.864. PMid:5531906.

9. Yampolsky C, Corti M, Negroni R. Fungal cerebral abscess in a diabetic patient successfully treated with surgery followed by prolonged antifungal therapy. Rev Iberoam Micol. 2010;27(1):6-9. http://dx.doi. org/10.1016/j.riam.2009.12.001. PMid:20189857.

10. Holyst J, Majewski A, Tyszkiewicz S. Massive cerebellar abscess due to candida albicans. Neurochirurgia (Stuttg). 1976;19(3):126-9. http:// dx.doi.org/10.1055/s-0028-1090401. PMid:934420.

11. Haruda F, Bergman MA, Headings D. Unrecognized Candida brain abscess in infancy: two cases and a review of the literature. Johns Hopkins Med J. 1980;147(5):182-5. PMid:7441937.

12. Thron A, Wiethölter H. Cerebral candidiasis: CT studies in a case of brain abscess and granuloma due to Candida albicans. Neuroradiology. 1982;23(4):223-5. http://dx.doi.org/10.1007/BF00342547. PMid:7121816.

13. Ilgren EB, Westmorland D, Adams CB, Mitchell RG. Cerebellar mass caused by Candida species. Case report. J Neurosurg. 1984;60(2):428- 30. http://dx.doi.org/10.3171/jns.1984.60.2.0428. PMid:6693969.

14. Ikeda K, Yamashita J, Fujisawa H, Fujita S. Cerebral granuloma and meningitis caused by Candida albicans: useful monitoring of mannan antigen in cerebrospinal fluid. Neurosurgery. 1990;26(5):860-3. http:// dx.doi.org/10.1227/00006123-199005000-00020. PMid:2352603.

15. Burgert SJ, Classen DC, Burke JP, Blatter DD. Candidal brain abscess associated with vascular invasion: a devastating complication of vascular catheter-related candidemia. Clin Infect Dis. 1995;21(1):202-5. http:// dx.doi.org/10.1093/clinids/21.1.202. PMid:7578733.

16. Kamitsuka MD, Nugent NA, Conrad PD, Swanson TN. Candida albicans brain abscesses in a premature infant treated with amphotericin B, flucytosine and fluconazole. Pediatr Infect Dis J. 1995;14(4):329-31. http://dx.doi.org/10.1097/00006454-199504000-00020. PMid:7603822.

17. Kaji M, Shoji H, Oizumi K. Intractable meningitis and intracranial abscess following sinusitis due to Candida species. Kurume Med J. 1998;45(3):279-81. http://dx.doi.org/10.2739/kurumemedj.45.279. PMid:9787599.

18. Prabhu RM, Orenstein R. Failure of caspofungin to treat brain abscesses secondary to Candida albicans prosthetic valve endocarditis. Clin Infect Dis. 2004;39(8):1253-4. http://dx.doi.org/10.1086/424449. PMid:15486856.

19. Pham LV, Quang AT, Ton Nu PA, Duc TT, Thi HN. Cladophialophora bantiana and Candida albicans mixed infection in cerebral abscess of an HIV-negative patient. J Infect Dev Ctries. 2008;2(3):245-8. http:// dx.doi.org/10.3855/jidc.271. PMid:19738359.

20. Baradkar VP, Mathur M, Kumar S. Cerebral Candida abscess in an infant. Indian J Med Microbiol. 2009;27(1):70-2. http://dx.doi. org/10.1016/S0255-0857(21)01762-X. PMid:19172068.

21. Wang GH, Dai CL, Liu YF, Li YM. Cerebral and renal abscess and retino-choroiditis secondary to Candida albicans in preterm infants: eight case retrospective study. Clin Exp Obstet Gynecol. 2013;40(4):519- 23. PMid:24597247.

22. Yoganathan S, Chakrabarty B, Gulati S, et al. Candida tropicalis brain abscess in a neonate: an emerging nosocomial menace. Ann Indian Acad Neurol. 2014;17(4):448-50. http://dx.doi.org/10.4103/0972- 2327.144036. PMid:25506171.

23. Strickland BA, Pham M, Bakhsheshian J, Carmichael J, Weiss M, Zada G. endoscopic endonasal transsphenoidal drainage of a spontaneous Candida glabrata pituitary abscess. World Neurosurg. 2018;109:467-70. http://dx.doi.org/10.1016/j.wneu.2017.10.060. PMid:29079259.

24. Zhu Z, Huang Z, Li Z, Li X, Du C, Tian Y. Multiple brain abscesses caused by infection with Candida glabrata: a case report. Exp Ther Med. 2018;15(3):2374-80. http://dx.doi.org/10.3892/etm.2018.5692. PMid:29456643.

25. Bilgin E, Ökten Aİ, Gezercan Y, et al. Pediatric giant cerebral Candida abscess: a case report. Pediatr Neurosurg. 2019;54(3):207-11. http:// dx.doi.org/10.1159/000500678. PMid:31238324.

26. Radhouane K, Bedioui A, Yedeas MD, et al. Brain abscess due to Candida glabrata in an immunocompetent patient. A case report with update and literature review. IDCases. 2020;22:e00996. http://dx.doi. org/10.1016/j.idcr.2020.e00996. PMid:33204632.

27. Zhu Y, Gong X, Li Z, Wang D, Yan C. Clinical analysis of intravenous and oral sequential treatment with voriconazole for Candida central nervous system infection in six premature infants. Front Pharmacol. 2021;12:631293. http://dx.doi.org/10.3389/fphar.2021.631293. PMid:34248616.

28. Yoshida K, Matsuda N, Sato T, et al. Candida brain abscesses in a patient with anorexia nervosa receiving total parenteral nutrition. Clin Neurol Neurosurg. 2022;212:107058. http://dx.doi.org/10.1016/j. clineuro.2021.107058. PMid:34844162.

29. Honda H, Warren DK. Central nervous system infections: meningitis and brain abscess. Infect Dis Clin North Am. 2009;23(3):609-23. http:// dx.doi.org/10.1016/j.idc.2009.04.009. PMid:19665086.

30. Gavito-Higuera J, Mullins CB, Ramos-Duran L, Olivas Chacon CI, Hakim N, Palacios E. Fungal infections of the central nervous system: a pictorial review. J Clin Imaging Sci. 2016;6:24. http://dx.doi. org/10.4103/2156-7514.184244. PMid:27403402.


1 MD, MSc, Neurosurgery Division, Faculty of Medicine, University of Sao Paulo – USP, São Paulo, SP, Brazil.

2 MD, Botucatu Medical School, Sao Paulo State University – UNESP, Botucatu, SP, Brazil.

3 MD, PhD, Botucatu Medical School, Neurosurgeon, Sao Paulo State University – UNESP, Botucatu, SP, Brazil.

 

Received Jul 13, 2023

Accepted Jul 21, 2023

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JBNC  Brazilian Journal of Neurosurgery

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