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BMC Research Notes

, 7:837

Infectious Diseases

Abstract

BackgroundFungal 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 presentationA 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.

ConclusionDespite 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.

KeywordsBrain abscess Candida albicans Invasive candidiasis Injection drug user Diabetes AbbreviationsABGArterial blood gas

ADCApparent diffusion coefficient

AFBAcid fast bacilli

BBBBlood–brain barrier

CNSCentral nervous system

CRPC-reactive protein

CSFCerebrospinal fluid

CTComputed tomography

DWIDiffusion weighted imaging

EBVEpstein-Barr virus

EEGElectroencephalogram

ENTEar-nose-throat

EREmergency room

ESCMIDEuropean Society of Clinical Microbiology and Infectious Diseases

GCSGlasgow coma scale

γ-GTγ-glutamyltransferase

HIVHuman immunodeficiency virus

IDUInjection drug user

IVIntravenous

MRIMagnetic resonance imaging

MRSAMethicillin-resistant Staphylocccus aureus

PCRPolymerase chain reaction

WBCWhite blood cell.

Electronic supplementary materialThe online version of this article doi:10.1186-1756-0500-7-837 contains supplementary material, which is available to authorized users.

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Autor: Nélia Neves - Lurdes Santos - Carina Reis - António Sarmento

Fuente: https://link.springer.com/







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