Abscesso cerebral por espécies de candida: uma condição ameaçadora à vida / Candida species brain abscess: a life-threatening condition

Mikaele de Souza Sales, Matheus de Menezes Bezerra Leite, Robson Caetano Guedes Assuncao, Lucas Lopes Grangeiro

Abstract


O abscesso cerebral por Candida spp. é uma condição ameaçadora à vida, mais comum em indivíduos imunocomprometidos, porém com relatos crescentes em pacientes imunocompetentes. Esta revisão sistemática objetiva avaliar os principais fatores de risco, para além de distúrbios imunológicos, relacionados ao abscesso cerebral por Candida, bem como os métodos diagnósticos e tratamentos recomendados. Foram utilizados os descritores DeCS “Brain abscess” e “Candida” para uma pesquisa na base de dados MEDLINE, restrita aos trabalhos publicados até dezembro de 2021, encontrando-se um total de 88 publicações; destes, 48 atenderam aos critérios de inclusão deste estudo. Observou-se que a idade média dos pacientes foi de 21 anos, com maior prevalência no sexo masculino (56%). Prematuridade (57%) e baixo peso ao nascer (57%), em crianças, além de uso prévio de antibióticos de amplo espectro (59%) e infecção prévia por Candida (47%), nos pacientes em geral, foram os principais fatores de risco identificados, enquanto 6% não apresentaram qualquer fator de risco. Alteração do nível de consciência (67%) e febre (47%) foram as principais manifestações clínicas e o diagnóstico foi realizado em grande parte por biópsia (65%). Candida albicans foi a espécie mais frequentemente envolvida (93%). A terapia antifúngica foi variável, sendo precedida por antibioticoterapia em 53% dos casos. A taxa de mortalidade foi de 24%. Houve retardo no início da terapia antifúngica na maioria dos casos devido à dificuldade diagnóstica, evidenciado a necessidade de alto nível de suspeição e métodos diagnósticos sensíveis para otimização da terapêutica e desfecho dos casos, com redução das taxas de mortalidade.


Keywords


abscesso cerebral, fatores de risco, candida.

References


BARADKAR, V. P.; MATHUR, M.; KUMAR, S. Cerebral Candida abscess in an infant. Indian journal of medical microbiology, [s. l.], v. 27, n. 1, p. 70–72, 2009.

BELL, W. E. Treatment of fungal infections of the central nervous system. Annals of neurology, [s. l.], v. 9, n. 5, p. 417–422, 1981.

BILGIN, E. et al. Pediatric Giant Cerebral Candida Abscess: A Case Report. Pediatric neurosurgery, [s. l.], v. 54, n. 3, p. 207–211, 2019.

BLACK, J. T. Cerebral candidiasis: case report of brain abscess secondary to Candida albicans, and review of literature. Journal of neurology, neurosurgery, and psychiatry, [s. l.], v. 33, n. 6, p. 864–870, 1970.

BURGERT, S. J. et al. Candidal brain abscess associated with vascular invasion: a devastating complication of vascular catheter-related candidemia. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, [s. l.], v. 21, n. 1, p. 202–205, 1995.

CHEN, S. C.-A.; SLAVIN, M. A.; SORRELL, T. C. Echinocandin antifungal drugs in fungal infections: a comparison. Drugs, [s. l.], v. 71, n. 1, p. 11–41, 2011.

CORNELY, O. A. et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, [s. l.], v. 18 Suppl 7, p. 19–37, 2012.

DE PAUW, B. et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, [s. l.], v. 46, n. 12, p. 1813–1821, 2008.

DOTIS, J.; ROILIDES, E. Immunopathogenesis of central nervous system fungal infections. Neurology India, [s. l.], v. 55, n. 3, p. 216–220, 2007.

FENNELLY, A. M. et al. Candida cerebral abscesses: a case report and review of the literature. Medical mycology, [s. l.], v. 51, n. 7, p. 779–784, 2013.

FIDEL, P. L., Jr; VAZQUEZ, J. A.; SOBEL, J. D. Candida glabrata: review of epidemiology, pathogenesis, and clinical disease with comparison to C. albicans. Clinical microbiology reviews, [s. l.], v. 12, n. 1, p. 80–96, 1999.

FRIEDLANDER, R. M. et al. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 16-2003. A 58-year-old woman with left-sided weakness and a right frontal brain mass. The New England journal of medicine, [s. l.], v. 348, n. 21, p. 2125–2132, 2003.

GEERLINGS, S. E.; HOEPELMAN, A. I. Immune dysfunction in patients with diabetes mellitus (DM). FEMS immunology and medical microbiology, [s. l.], v. 26, n. 3–4, p. 259–265, 1999.

GOODKIN, H. P.; HARPER, M. B.; POMEROY, S. L. Intracerebral abscess in children: historical trends at Children’s Hospital Boston. Pediatrics, [s. l.], v. 113, n. 6, p. 1765–1770, 2004.

HOLYST, J.; MAJEWSKI, A.; TYSZKIEWICZ, S. Massive cerebellar abscess due to candida albicans. Neurochirurgia, [s. l.], v. 19, n. 3, p. 126–129, 1976.

HONDA, H.; WARREN, D. K. Central nervous system infections: meningitis and brain abscess. Infectious disease clinics of North America, [s. l.], v. 23, n. 3, p. 609–623, 2009.

ILGREN, E. B. et al. Cerebellar mass caused by Candida species. Case report. Journal of neurosurgery, [s. l.], v. 60, n. 2, p. 428–430, 1984.

JAFARI, H. S. et al. Effects of antifungal therapy on inflammation, sterilization, and histology in experimental Candida albicans meningitis. Antimicrobial agents and chemotherapy, [s. l.], v. 38, n. 1, p. 83–89, 1994.

JARVIS, W. R. Epidemiology of nosocomial fungal infections, with emphasis on Candida species. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, [s. l.], v. 20, n. 6, p. 1526–1530, 1995.

JOHNSON, S. C.; KAZZI, N. J. Candida brain abscess: a sonographic mimicker of intracranial hemorrhage. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, [s. l.], v. 12, n. 4, p. 237–239, 1993.

KAMITSUKA, M. D. et al. Candida albicans brain abscesses in a premature infant treated with amphotericin B, flucytosine and fluconazole. The Pediatric infectious disease journal, [s. l.], v. 14, n. 4, p. 329–331, 1995.

KANTOR, H. L. et al. Candida albicans meningitis in a parenteral drug abuser. Southern medical journal, [s. l.], v. 77, n. 3, p. 404–405, 1984.

LAI, P. H. et al. Disseminated miliary cerebral candidiasis. AJNR. American journal of neuroradiology, [s. l.], v. 18, n. 7, p. 1303–1306, 1997.

LIPTON, S. A. et al. Candidal infection in the central nervous system. The American journal of medicine, [s. l.], v. 76, n. 1, p. 101–108, 1984.

MAMELAK, A. N. et al. Improved management of multiple brain abscesses: a combined surgical and medical approach. Neurosurgery, [s. l.], v. 36, n. 1, p. 76–85, 1995.

MARCINKOWSKI, M. et al. Fungal brain abscesses in neonates: Sonographic appearances and corresponding histopathologic findings. Journal of clinical ultrasound : JCU, [s. l.], v. 29, n. 7, p. 417–421, 2001

MARR, K. A. Invasive Candida infections: the changing epidemiology. Oncology (Williston Park, N.Y.), [s. l.], v. 18, n. 14 Suppl 13, p. 9–14, 2004.

NGUYEN, M. H.; YU, V. L. Meningitis caused by Candida species: an emerging problem in neurosurgical patients. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, [s. l.], v. 21, n. 2, p. 323–327, 1995.

NATHOO, N. et al. Brain abscess: management and outcome analysis of a computed tomography era experience with 973 patients. World neurosurgery, [s. l.], v. 75, n. 5–6, p. 716–726, 2011.

NEVES, N. et al. Candida albicans brain abscesses in an injection drug user patient: a case report. BMC research notes, [s. l.], v. 7, p. 837, 2014.

PAPPAS, P. G. et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, [s. l.], v. 48, n. 5, p. 503–535, 2009.

PARKER, J. C., Jr; MCCLOSKEY, J. J.; LEE, R. S. The emergence of candidosis. The dominant postmortem cerebral mycosis. American journal of clinical pathology, [s. l.], v. 70, n. 1, p. 31–36, 1978.

PENDLEBURY, W. W.; PERL, D. P.; MUNOZ, D. G. Multiple microabscesses in the central nervous system: a clinicopathologic study. Journal of neuropathology and experimental neurology, [s. l.], v. 48, n. 3, p. 290–300, 1989.

PFALLER, M. A. et al. National surveillance of nosocomial blood stream infection due to species of Candida other than Candida albicans: frequency of occurrence and antifungal susceptibility in the SCOPE Program. SCOPE Participant Group. Surveillance and Control of Pathogens of Epidemiologic. Diagnostic microbiology and infectious disease, [s. l.], v. 30, n. 2, p. 121–129, 1998.

PHAM, L. V. et al. Cladophialophora bantiana and Candida albicans mixed infection in cerebral abscess of an HIV-negative patient. Journal of infection in developing countries, [s. l.], v. 2, n. 3, p. 245–248, 2008.

PRABHU, R. M.; ORENSTEIN, R. Failure of caspofungin to treat brain abscesses secondary to Candida albicans prosthetic valve endocarditis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, [s. l.], v. 39, n. 8, p. 1253–1254, 2004.

RAMAN SHARMA, R. Fungal infections of the nervous system: current perspective and controversies in management. International journal of surgery (London, England), [s. l.], v. 8, n. 8, p. 591–601, 2010.

RENIER, D. et al. Brain abscesses in neonates. A study of 30 cases. Journal of neurosurgery, [s. l.], v. 69, n. 6, p. 877–882, 1988.

SÁNCHEZ-PORTOCARRERO, J. et al. The central nervous system and infection by Candida species. Diagnostic microbiology and infectious disease, [s. l.], v. 37, n. 3, p. 169–179, 2000.

SELBY, R. et al. Brain abscess in solid organ transplant recipients receiving cyclosporine-based immunosuppression. Archives of surgery (Chicago, Ill. : 1960), [s. l.], v. 132, n. 3, p. 304–310, 1997.

SINGHI, P.; SAINI, A. G. Fungal and Parasitic CNS Infections. Indian journal of pediatrics, [s. l.], v. 86, n. 1, p. 83–90, 2019.

SMEGO, R. A., Jr; PERFECT, J. R.; DURACK, D. T. Combined therapy with amphotericin B and 5-fluorocytosine for Candida meningitis. Reviews of infectious diseases, [s. l.], v. 6, n. 6, p. 791–801, 1984.

THRON, A.; WIETHÖLTER, H. Cerebral candidiasis: CT studies in a case of brain abscess and granuloma due to Candida albicans. Neuroradiology, [s. l.], v. 23, n. 4, p. 223–225, 1982.

TOKSOY, Hayri B. et al. Neonatal Cerebral Candida Abscess: Radiologic and Clinical Findings. Tr. J. of Medical Sciences, [s. l.], v. 29, p. 345-348, 1999.

TSENG, J.-H.; TSENG, M.-Y. Brain abscess in 142 patients: factors influencing outcome and mortality. Surgical neurology, [s. l.], v. 65, n. 6, p. 557–562, 2006.

YAMPOLSKY, C.; CORTI, M.; NEGRONI, R. Fungal cerebral abscess in a diabetic patient successfully treated with surgery followed by prolonged antifungal therapy. Revista iberoamericana de micologia, [s. l.], v. 27, n. 1, p. 6–9, 2010

YOGANATHAN, S. et al. Candida tropicalis brain abscess in a neonate: An emerging nosocomial menace. Annals of Indian Academy of Neurology, [s. l.], v. 17, n. 4, p. 448–450, 2014.

ZHU, Z. et al. Multiple brain abscesses caused by infection with Candida glabrata : A case report. Experimental and therapeutic medicine, [s. l.], v. 15, n. 3, p. 2374–2380, 2018.




DOI: https://doi.org/10.34119/bjhrv5n3-084

Refbacks

  • There are currently no refbacks.