Clinical value of cranial MRI in the diagnosis and treatment of central nervous system candidiasis

HU Hui-Li; HU Bing; CHEN He-Ying; CHEN Tian-Ming; LI Shao-Ying; CHENG Hua; LIU Gang

doi:10.7499/j.issn.1008-8830.2014.08.013

PDF(2111 KB)

Chinese Journal of Contemporary Pediatrics ›› 2014, Vol. 16 ›› Issue (8) : 834-839. DOI: 10.7499/j.issn.1008-8830.2014.08.013

CLINICAL RESEARCH

Clinical value of cranial MRI in the diagnosis and treatment of central nervous system candidiasis

HU Hui-Li¹, HU Bing¹, CHEN He-Ying¹, CHEN Tian-Ming¹, LI Shao-Ying¹, CHENG Hua², LIU Gang¹

Author information +

History +

Abstract

Objective To study the clinical value of cranial magnetic resonance imaging (MRI) in the diagnosis and treatment of central nervous system candidiasis (CNSC), which has no specific clinical manifestations and has no rapid and specific diagnostic tools. Methods A retrospective analysis was performed on the clinical data of 10 children who were diagnosed with CNSC in Beijing Children's Hospital Affiliated to Capital Medical University between 2009 and 2013. Results Nine of the 10 children underwent cranial MRI within 8 days after admission, and 5 of the 9 children underwent contrast-enhanced MRI at the same time. Eight of the 9 children showed the features of meningoencephalitis, and 6 cases were accompanied by varying degrees of brain atrophy; one case showed hydrocephalus and cerebral abscess, and another case showed leukoencephalopathy. Six cases were found to have the features of cerebral vasculitis after infection in the first MRI after admission, including cerebral infarction (2 cases), venous sinus thrombosis (3 cases), and Moyamoya disease (1 case). Infectious granulomatous lesions were confirmed by contrast-enhanced MRI in 3 cases. Given the clinical manifestations, 8 of the 9 cases were diagnosed as suspected CNSC after MRI, and 7 of these cases received antifungal therapy before the pathogen test results were returned. The lesions on MRI were improved in 6 cases after 3-4 weeks of antifungal treatment. All the 10 children were diagnosed with CNSC by positive cerebrospinal fluid culture results. Conclusions Cranial MRI, especially contrast-enhanced MRI, is of great significance for the diagnosis and treatment of CNSC. To confirm the guidance of MRI in the diagnosis and treatment of CNSC, further case-control studies are needed.

Key words

Central nervous system candidiasis / Cranial MRI / Cerebral vasculitis / Infectious granuloma / Child

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

HU Hui-Li, HU Bing, CHEN He-Ying, CHEN Tian-Ming, LI Shao-Ying, CHENG Hua, LIU Gang. Clinical value of cranial MRI in the diagnosis and treatment of central nervous system candidiasis[J]. Chinese Journal of Contemporary Pediatrics. 2014, 16(8): 834-839 https://doi.org/10.7499/j.issn.1008-8830.2014.08.013

References

[1] Raparia K, Powell SZ, Cernoch P, et al. Cerebral mycosis: 7-year retrospective series in a tertiary center[J]. Neuropathology, 2010, 30(3): 218-223.
[2] Rajshekhar V. Surgical management of intracranial fungal masses[J]. Neurol India, 2007, 55(3): 267-273.
[3] 胡冰, 陈荷英, 刘钢, 等. 婴儿中枢神经系统白色念珠菌病5 例并文献复习[J]. 中国循证儿科杂志, 2011, 6(5): 386-390.
[4] Sánchez-Portocarrero J, Pérez-Cecilia E, Corral O, et al. The central nervous system and infection by Candida species[J]. Diagn Microbiol Infect Dis, 2000, 37(3): 169-179.
[5] Moylett EH. Neonatal candida meningitis[J]. Semin Pediatr Infect Dis, 2003, 14(2): 115-122.
[6] Faix RG, Chapman RL. Central nervous system candidiasis in the high-risk neonate[J]. Semin Perinatol, 2003, 27(5): 384-392.
[7] Park SY, Kim SH, Choi SH, et al. Clinical and radiological features of invasive pulmonary aspergillosis in transplant recipients and neutropenic patients[J]. Transpl Infect Dis, 20l0, 12(4): 309-315.
[8] Torelli R, Sanguinetn M, Moody A, et a1. Diagnosis of invasive aspegillosis by a commercial real-time PCR assay for aspergillus DNA in bronchoalveolar lavage fluid samples from high-risk patients compared to a galactomaonnan enzyme immunoassay[J]. J Clin Microbiol, 201l, 49 (12): 4273-4278.
[9] 许攀峰, 周建英, 周华, 等. 血清抗原检测联合肺部CT 诊断侵袭性肺曲霉病的探讨[J]. 浙江大学学报( 医学版), 2012, 41(3): 332-338.
[10] Chen TL, Chen HP, Fung CP, et al. Clinical characteristics, treatment and prognostic factors of candial meningitis in a teaching hospital in Taiwan[J]. Scand J Infect Dis, 2004, 36(2): 124-130.
[11] Sanchez-Portoacarrero J, Perez-Cecilia E, Corral O, et al. The central nervous system and infection by candida species[J]. Diagn Microbiol infect Dis, 2000, 37(3): 169-179.
[12] Pappas PG, kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis, 2009 update by the Infectious Disease Society of Ameriea[J]. Cin Infect Dis, 2009, 48(5): 503-535.
[13] 毛健, 李娟, 陈丹, 等.核磁共振成像在早产儿白色念珠菌感染脑脓肿诊断中的意义[J]. 中国当代儿科杂志, 2011,13(8): 621-626.
[14] Lai PH, Lin SM, Pan HB, et al. Disseminated miliary cerebral candidiasis[J]. AJNR Am J Neuroradiol, 1997, 18(8): 1303- 1305.
[15] Huang CC, Chen CY, Yang HB, et al. Central nervous system candidiasis in very low-birth-weight premature neonates and infants: US characteristics and histolopathologic and MR imaging correlates in five patients[J]. Radiology, 1998, 209(1): 49-56.
[16] 中华医学会“念珠菌病诊治策略高峰论坛专家组. 念珠菌病诊断与治疗: 专家共识中国感染与化疗杂志, 2011, 11(2): 81- 95.
[17] 彭如臣, 沈秀芝, 高焕峰, 等. 粟粒性脑结核病的MR 特征[J]. 中华放射学杂志, 2006, 40(12): 1254-1255.
[18] Haris M, Gupta RK, Husain M, et al. Assessment of therapeutic response in brain tuberculomas using serial dynamic contrastenhanced MRI[J]. Clin Radiol, 2008, 63(5): 562-574.
[19] Kim HJ, Shim KW, Lee MK, et al. Tuberculous encephalopathy without meningitis: pathology and brain MRI findings[J]. Eur Neurol, 2011, 65(3): 156-159.
[20] Chatterjee S, Saini J, Kesavadas C, et al. Differentiation of tubercular infectionand perfusion magnetic resonance imaging[J]. J Neororadiol, 2010, 37(3):167-171.