Queiroz L S, Nucci A, De Faria J L
Arq Neuropsiquiatr. 1976 Mar;34(1):18031.
Central nervous system involvement in Candida septicaemia is rare and not more than four cases have been published in Brazil. Five new cases of systemic candidiasis with cerebral lesions are reported. All patients (four adults and a child) had serious underlying diseases and were submitted to heavy long-term antibiotic therapy with multiple drugs. Seizures in one case and neck stiffness in another were the only neurologic signs that could be attributed to candidiasis. In no case were the lesions severe enough to be considered an immediate cause of death. In three patients, no macroscopic changes were evident in the brain, but microabscesses and granulomata were observed on microscopical examination; another patient had two gross areas with necrotic and haemorrhagic appearance in the cerebral hemispheres; the child had only two microscopic granulomata. The aetiological agent was demonstrated by Grocott's methenamine silver technique in all cases. Involvement of organs other than the central nervous system could be demonstrated in three autopsies. Discussion is confined mainly to such aspects as the contributory factors in the pathogenesis of systemic candidiasis as well as the marked rise in the incidence of this condition in the past few decades. It is suggested that the frequence of monilial septicaemia in Brazil may be far more serious than apparent from the scarcity of reported cases.
念珠菌败血症累及中枢神经系统较为罕见，巴西已发表的病例不超过4例。本文报告了5例伴有脑损害的系统性念珠菌病新病例。所有患者（4名成人和1名儿童）均患有严重的基础疾病，并长期接受多种强效抗生素治疗。1例出现癫痫发作，另1例出现颈部强直，这是仅有的可归因于念珠菌病的神经学体征。在所有病例中，病变均未严重到可被视为直接死因。3例患者脑部未见明显宏观变化，但显微镜检查发现微脓肿和肉芽肿；另1例患者大脑半球有2个肉眼可见的坏死和出血区域；该儿童仅有2个显微镜下可见的肉芽肿。所有病例均通过格罗科特六胺银染色技术证实了病原体。3例尸检显示除中枢神经系统外其他器官也受到累及。讨论主要集中在系统性念珠菌病发病机制中的促成因素以及过去几十年中该病发病率显著上升等方面。有人认为，巴西念珠菌败血症的实际发生率可能远比报告病例数稀少所显示的情况严重得多。
