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considered as a pathogen, and the diagnosis was clear more likely to be opportunistic infections. The situation
as systemic non‑albicans candida infections mainly is more or less similar in China and Brazil. [9]
presented as non‑albicans candidal meningitis. She
received amphotericin B 1 mg/day and fluconazole We summarize, the clinical features of this patient:
400 mg/day intravenously as soon as diagnosis is clear. (1) a 42‑year‑old woman, acute onset of fever, which
Unfortunately, the patient discharged from the hospital is resistant to the antibiotics and antituberculosis
on the second day since administration of antifungal agents; (2) liver dysfunction, intra‑liver lesion, biliary
drugs because of economic reasons and hence we could ducts dilation; (3) hilar and portal hepatis lymph nodes
not observe the therapeutic effect. enlargement; (4) used of broad‑spectrum antibiotics in
the early stage of the disease when the diagnosis was
DISCUSSION unclear; (5) with a low immune state, which was the
basis of opportunistic infections. We considered the
Many strains of fungal can cause CNS infection. case was blastomycosis according to the lymph node
Aspergillus, mucor, cryptococcosis, and yeast are the biopsy results. Morphologically, giant blastoconidia
[2]
most common strains in China. A foreign research presented a spectrum of forms such as blastoconidia
showed that yeast, aspergillus, and cryptococcosis was with linear creases, with single broad‑based buds
the most common fungal pathogens for CNS infection resembling Blastomyces dermatididis, with multiple
in immune‑competent hosts, while aspergillus, candida buds resembling Paracoccidioides brasiliensis. Its forms
and nocardia were the most common pathogens in varied along with the environment and temperature.
patients with impaired immunity. [3‑5] Many factors Such as, after growth on commercially prepared cultures
contributed to the increasing incidence of systemic in room temperature, we can see white fluffy colonmold
candidiasis, such as HIV transmission, the using to naked eyes and the characteristic thick‑walled
of hormonal, immunosuppressive agents and broad‑based yeast in microscope with Periodic
broad‑spectrum antibiotics, organ transplantation, acid Schiff staining, as it shows mycelia‑like type, while
the invasive intracranial examination, and so on. been cultured in 37 °C it presents on brown and frilly
This patient has an infection of hepatitis B virus, and yeast‑like colony, and in tissue it shows yeast‑like type.
uncertained cholangio carcinoma. Her immune system Candida includes yeast type and pseudohyphae type
was weak, such kind of patients should be considered and produces blastoconidium. In this case, we can see
of rare bacterial or fungus infection at the initial of blastoconidia only with India ink staining in CSF and
treatment. Therefore, fungi, and bacterial culture could lymph node puncture fluid culture. Brain biopsy hadn’t
be done more actively. been done. Combing with the manifestation, brain
MRI, CSF tests, and fungus culture results, we highly
Candida albicans was the most common pathogen suspected systematic candidal albicans infection. This
[6]
of candidiasis in the past, and the proportion of case reminds us that it is essential to do CSF culture
nonblastomyces albicans infection has tended to rise for patients with unexplained CNS infection, not
recently. However, meningitis caused by non‑albicans only the routine CSF cell counts and protein tests. If
candida is rare in the clinic and does not have specific the diagnosis is established, patients should receive
manifestations, which make the misdiagnosis occur antifungal treatment based on drug sensitivity test as
sometimes, especially in the early stage of the disease. early as possible.
This case reminds us that candidiasis should be
considered if we found patients had unexplained fever REFERENCES
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