The emergence of candidosis. The dominant postmortem cerebral mycosis

Abstract

Comparable human postmortem surveys in central Kentucky and southern Florida have demonstrated an altered pattern of cerebral mycoses due primarily to therapeutic manipulations. From both states 8,975 complete autopsies yielded 39 patients with histologically verified cerebral mycoses. The most common infection was candidosis (49%), characterized by intraparenchymal microabscesses without significant leptomeningitis in hospitalized patients compromised by antibiotic therapy for infection with gram-negative organisms. The remaining 20 patients with noncandidal cerebral mycoses included 9 (23%) with cryptococcosis, 5 (13%) with zygomycosis, 2 (5%) with aspergillosis, 2 (5%) with histoplasmosis, 1 (2.5%) with blastomycosis and 1 (2.5%) with curvulariosis. These compromised patients had leptomeningitis when infected with yeasts and cerebral infarcts with cerebritis when infected with hyphal fungi. In contrast to human cerebral candidosis, the non-candidal cerebral mycoses precipitated the patient's terminal hospitalization. These infections seemed to be contracted outside the hospital. Therapy for gram-negative bacterial infections has enabled Candida species to overtake Cryptococcus neoformans as the most common cause of postmortem cerebral mycosis.