Abstract OBJECTIVE: To explore the value of serial magnetic resonance imaging (MRI) in the diagnosis of cerebral abscess caused by Candida albicans in premature infants. METHODS: The clinical data of 8 premature infants with central nervous system invasive fungal infection (IFI) were retrospectively studied. The infants underwent serial cerebral MRI scans (T1WI, T2WI and DWI). RESULTS: Candida albicans was found as pathogen in all of the 8 infants. Seven infants presented with cerebral abscess and 4 infants had concurrent meningitis. Widespread involvements were found on MRI, particular in white matter area of subcortex, centrum semiovale and periventricle. The MR imaging findings in 4 infants within 11 days after IFI showed diffusive and multiple miliary nodes and hyperintense signals on DWI, but obvious changes were not found on T1WI and T2WI. The most striking hyperintense signals on T1WI and hypointense signals on T2WI appeared between 2 and 4 weeks after IFI, and some nodes of rim-like hyperintensity and marked contrast enhancement were also noted on T1WI. Smaller and smaller changes of the miliary foci were seen on T1WI and T2WI 4 weeks later. Delayed myelination and thinner corpus callous were shown in 2 patients at three months. CONCLUSIONS: MRI-DWI and serial MRIs are helpful in the early diagnosis of candida cerebral abscess and the evaluation of treatment outcome in premature infants.
MAO Jian,LI Juan,CHEN Dan et al. Value of MRI in the diagnosis of cerebral abscess caused by Candida albicans in premature infants[J]. 中国当代儿科杂志, 2011, 13(8): 621-626.
MAO Jian,LI Juan,CHEN Dan et al. Value of MRI in the diagnosis of cerebral abscess caused by Candida albicans in premature infants[J]. CJCP, 2011, 13(8): 621-626.
［1］Stoll BJ, Hansen N. Infections in VLBW infants:studies from the NICHD Neonatal Research Network［J］.Semin Ｐerinatol, 2003, 27(4): 293-301.
［2］Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR,Vohr B, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection［J］. JAMA, 2004, 292(19): 23572365.
［3］Sánchez-Portocarrero J, Pérez-Cecilia E, Corral O, Romero-Vivas J, Picazo JJ. The central nervous system and infection by Candida species［J］. Diagn Microbiol Infect Dis, 2000, 37(3): 169-179.
［5］Faix RG, Chapman RL. Central nervous system candidiasis in the high-risk neonate［J］. Semin Perinatol, 2003, 27(5):384-392.
［6］Smith PB, Garges HP, Cotton CM, Walsh TJ, Clark RH, Benjamin DK Jr. Meningitis in preterm neonates: importance of cerebrospinal fluid parameters［J］. Am J Perinatol, 2008, 25(7): 421-426.
［7］Bozynski ME, Naglie RA, Russell EJ. Real-time ultrasonographic surveillance in the detection of CNS involvement in systemic Candida infection［J］. Pediatr Radiol, 1986, 16(3): 235-237.
［8］Tung KT, MacDonald LM, Smith JC. Neonatal systemic candidiasis diagnosed by ultrasound［J］. Acta Radiol, 1990, 31(3): 293-295.
［10］Huang CC, Chen CY, Yang HB, Wang SM, Chang YC, Lin CC. 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.
［11］Ferrari P, Chiarolanza J, Capriotti T, Garetti E, Venuta A. Favorable course of cerebral candidiasis in a low-birth newborn treated with liposomal amphotericin B［J］. Pediatr Med Chir, 2001, 23(3-4): 197-199.
［12］Pahud BA, Greenhow TL, Piecuch B, Weintrub PS. Preterm neonates with candidal brain microabscesses: a case series［J］. J Peinatol, 2009, 29(4): 323326.
［13］Binning MJ, Lee J, Thorell EA, Riva-Cambin JK. Intraventricular fungus ball:a unique manifestation of refractory intracranial candidiasis in an immunocompetent neonate［J］. J Neurosurg Pediatr, 2009, 4(6): 584-587.
［14］López Sastr JB, Coto Cotallo GD, Fern-ndez Colomer B. Neonatal invasive candidiasis: a prospective multicenter study of 118 cases［J］. Am J Perinatol, 2003, 20(3): 153-163.
［15］Fernandez M, Moylett EH, Noyola DE, Baker CJ. Candidal meningitis in neonates: a 10-year review［J］. Clin Infet Dis, 2000, 31(2): 458-463.
［16］Benjamin DK Jr, Poole C, Steinbach WJ, Rowen JL, Walsh TJ. Neonatal candidemia and end-organ damage: a critical appraisal of the literature using meta-analytic techniques［J］. Pediatrics, 2003, 112(3 Pt 1): 634-640.
［17］Lee BE, Cheung PY, Robinson JL, Evanochko C, Roberson CM. Comparative study of mortality and morbidity in premature infants(birth weight, ＜1,250 g)with candidemia or candidal meningitis［J］. Clin Infect Dis, 1998, 27(3): 559-565.
［18］Pendlebury WW, Perl DP, Munoz DG. Multiple microabscesses in the central nervous system: a clinicopathologic study［J］. J Neuropathol Exp Neurol, 1989, 48(3): 290-300.
［19］Lai PH, Lin SM, Pan HB, Yang CH. Disseminated miliary cerebral candidiasis［J］. AJNR Am J Neuroradiol, 1997, 18(8): 1303-1305.
［20］Friedman S, Richardson SE, Jacobs SE, O′Brien K. Systemic Candida infection in extremely low birth weight infants: short term morbidity and long term neurodevelopmental outcome［J］. Pediatr Infect Dis J, 2000, 19(6): 499-504.
［21］Jong AY, Stins MF, Huang SH, Chen SH, Kim KS. Transversal of Candida albicans across human blood-brain barrier in vitro［J］. Infet Immun, 2001, 69(7): 4536-4544.
［22］Becker LE. Infections of the developing brain［J］.AJNR Am J Neuroradiol, 1992, 13(2): 537-549.
［23］Chang KH, Han MH, Roh JK, Kim IO, Han MC, Choi KS, et al. Gd-DTPA enhanced MR imaging in intracranial tuberculosis［J］. Neuroradiology, 1990, 32(1): 19-25.
［24］Mueller-Mang C, Castillo M, Mang TG, Cartes-Zumelzu F, Weber M, Thurner MM. Fungal versus bacterial brain abscesses：is diffusion-weighted MR imaging a useful tool in the differential diagnosis?［J］. Neuroradiology, 2007, 49(8): 651-657.
