Candidosis: the most common postmortem cerebral mycosis in an endemic fungal area.

To determine the recent postmortem character of cerebral mycoses, 1,752 consecutive complete autopsies done in the endemic fungal area of central Kentucky from 1964 through 1973 were reviewed. Fourteen patients (0.8%) had histologically confirmed fungal infections in the brain. The most prevalent fungus was Candida spp. which was observed in six patients. Cryptococcosis was recognized in three patients; histoplasmosis in two; zygomycosis in two; and blastomycosis in one. In every patient these fungi were also seen in tissues outside the central nervous system and were identified microbiologically in nine. Unlike the pathogenic yeasts, Candida spp. and the zygomycetes produced intracerebral lesions without any significant meningeal reactions. Cerebral candidosis was recognized only at autopsy in patients compromised by previous multiple antibiotic therapy for gram-negative infections. On the other hand, immunosuppression was associated more commonly with the non-candidal fungal infections. An experimental model for systemic candidosis in adult Sprague-Dawley rats likewise demonstrated its difficult antemorten recognition even with cerebral lesions. Although clinical consequences from candidemia seem often inapparent, the associated intracerebral lesions may further compromise the altered host. Their frequency and significance remain to be elucidated.