Voice R A, Bradley S F, Sangeorzan J A, Kauffman C A
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
Clin Infect Dis. 1994 Jul;19(1):60-6. doi: 10.1093/clinids/19.1.60.
Chronic meningitis is an uncommon manifestation of candidiasis. We present the case of an elderly woman who had symptoms such as headache, malaise, and fever for 8 months and was found to have Candida albicans meningitis, and we review 17 similar cases. An underlying illness or risk factor for candidiasis was present in only 13 (72%) of the 18 patients. Headache, fever, and nuchal rigidity were the predominant clinical findings. Analysis of CSF showed either mononuclear or neutrophilic pleocytosis, an elevated protein level, and a decreased level of glucose. Only 17% of CSF smears were positive, and only 44% of initial CSF cultures yielded Candida species. In four cases, Candida species grew only after special techniques were used; in three cases, CSF cultures remained negative. The overall mortality associated with candidal meningitis was 53%, but among 12 patients who were treated and followed, the rate was 33%. In addition to acute meningitis seen with disseminated infection, Candida species can cause chronic meningitis that mimics tuberculosis and the more common fungal meningitides, such as cryptococcosis.
慢性脑膜炎是念珠菌病的一种罕见表现形式。我们报告了一例老年女性病例，该患者出现头痛、不适和发热等症状达8个月，被诊断为白色念珠菌性脑膜炎，同时我们还回顾了17例类似病例。18例患者中仅有13例（72%）存在念珠菌病的基础疾病或危险因素。头痛、发热和颈项强直是主要的临床发现。脑脊液分析显示单核细胞或中性粒细胞增多、蛋白水平升高以及葡萄糖水平降低。脑脊液涂片仅17%呈阳性，初始脑脊液培养仅44%培养出念珠菌属。4例患者仅在采用特殊技术后才培养出念珠菌属；3例患者脑脊液培养始终为阴性。念珠菌性脑膜炎的总体死亡率为53%，但在12例接受治疗并随访的患者中，死亡率为33%。除了播散性感染时出现的急性脑膜炎外，念珠菌属可引起类似结核病以及更常见的真菌性脑膜炎（如隐球菌病）的慢性脑膜炎。
