Though candidiasis is the most frequent invasive fungal infection, Candida spp. central nervous system (CNS) infections are rare but severe. To further describe clinico-patho-radiological presentations of this entity, we report a retrospective study from January 2005 to December 2018 including patients aged ≥ 28 days with proven or probable CNS candidiasis in France. Twenty-four patients were included. Seventeen patients (70%) had CNS localization secondary to disseminated candidiasis (10 with hematologic malignancies [HM]; the seven other patients had infective endocarditis [IE]). Among patients with HM, seven previously had lumbar puncture for intrathecal chemotherapy, the three others had IE. Among patients with disseminated infection, magnetic resonance imaging (MRI) evidenced meningitis (17%), micro-abscesses (58%), or vascular complications (67%). Seven patients (30%) had isolated CNS involvement related to neurosurgery (n = 2), CARD9 deficiency (n = 2), intravenous drug use, diabetes mellitus, or no identified predisposing condition (n = 1 each). All evaluated patients with isolated CNS involvement had meningitis on cerebrospinal fluid (CSF) and intracranial hypertension. For the latter patients, MRI evidenced meningitis (71%) or abscesses (57%). Among all patients, cerebrospinal fluid (CSF) culture grew Candida spp. in 31% of cases. CSF βDGlucan or mannan Ag were positive in respectively 86% and 80% of cases. Mortality attributed to CNS candidiasis was 42%: 53% in case of disseminated infection (70% for HM) and 14% in case of localized infection. CNS candidiasis are isolated or occur during disseminated infection in patients with HM and lumbar puncture for intrathecal chemotherapy or during IE. Clinical, radiological finding and outcome highly vary according to CNS localized versus disseminated candidiasis.

中文翻译：

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新生儿以外的中枢神经系统念珠菌病：一项全国性研究的教训。

虽然念珠菌病是最常见的侵袭性真菌感染，但念珠菌spp. 中枢神经系统 (CNS) 感染罕见但严重。为了进一步描述该实体的临床-病理-放射学表现，我们报告了一项从 2005 年 1 月至 2018 年 12 月的回顾性研究，包括在法国确诊或可能患有 CNS 念珠菌病的年龄≥28 天的患者。包括 24 名患者。17 名患者（70%）继发于播散性念珠菌病（10 名患有恶性血液病 [HM]；其他 7 名患者患有感染性心内膜炎 [IE]）。在 HM 患者中，有 7 人曾接受过腰椎穿刺鞘内化疗，另外 3 人有 IE。在播散性感染患者中，磁共振成像 (MRI) 证实有脑膜炎 (17%)、微脓肿 (58%) 或血管并发症 (67%)。n  = 2)、CARD9 缺乏症 ( n  = 2)、静脉内吸毒、糖尿病或未发现易感疾病 ( n  = 1)。所有评估的孤立性 CNS 受累患者均患有脑脊液 (CSF) 和颅内高压脑膜炎。对于后者患者，MRI 证实有脑膜炎 (71%) 或脓肿 (57%)。在所有患者中，脑脊液 (CSF) 培养培养出念珠菌spp. 在 31% 的情况下。CSF βD葡聚糖或甘露聚糖抗原分别在 86% 和 80% 的病例中呈阳性。中枢神经系统念珠菌病的死亡率为 42%：播散性感染为 53%（HM 为 70%），局部感染为 14%。中枢神经系统念珠菌病是孤立的或发生在 HM 患者的播散性感染和腰椎穿刺进行鞘内化疗或 IE 期间。根据 CNS 局限性和播散性念珠菌病，临床、放射学发现和结果差异很大。