UNUSUAL COURSE OF CANDIDA INFECTION OF TH E CENTRAL-NERVOUS-SYSTEM

Six months after an attack of pyelonephritis, adnexitis and candida co lpitis an 18-year-old girl developed some clouding of consciousness. O n neurological examination she showed organic behavioural changes, dis crete anisocoria and possible meningism. Computed tomography revealed hydrocephalus and signs of increased cerebrospinal fluid (CSF) pressur e. CSF contained 2336/3 cells, while total protein was raised to 7.0 g /l and lactate concentration to 6.85 mmol/l. Glucose concentration in CSF was 51 mg/dl and 75 mg/dl in serum. As tuberculous meningitis was suspected, treatment was started with four tuberculostatic drugs, but there was no improvement. Five weeks later microscopic CSF examination showed fungal spores and nonbranching hyphae. The maximal candida hae magglutination titre in CSF was 1 : 2048. CSF culture grew Candida alb icans. The further course was complicated by side effects to the antim ycotic drugs (amphotericin B between 4.5 and 45 mg daily; flucytosine 1.7 g four times daily) and recurrent obstruction in the ventricular s ystem requiring repeated neurosurgical interventions. However, full cu re was achieved after seven months' hospital treatment.