Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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October 15, 2012
Neonatal Candida Albicans Brain Abscesses
- Occurs in up to 70% of premature neonates with systemic fungal infection.
- Preterm infants at risk: Immature immune system and steroids for lung expansion.
- Blood cultures may be negative even in setting of positive CSF cultures.
- Further evaluation with echocardiogram, renal US, and ophthalmological exam for systemic candidal infection is recommended.
- Four stages: Early and late cerebritis, followed by early and late capsule formation.
- Key Diagnostic Features: Appearance depends on stage, but development is rapid. Sonography demonstrates multiple hyperechoic areas, which progress to hypoechoic lesions with peripheral hyperechogenicity. MRI demonstrates multiple rounded lesions demonstrating T1 hypointensity and T2 hyperintensity, peripheral enhancement, as well as restricted diffusion. Typically involves the frontal and parietal periventricular white matter.
- DDx: bacterial abscess, resolving hematoma, subacute infarct, neoplasm, cysticercosis, tuberculoma
- Rx: antifungal agents with CNS penetration, e.g., Amphotericin B or fluconazole
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