{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:18:24Z","timestamp":1792783104808,"version":"4.5.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universidade De S\u00e3o Paulo","id":[{"id":"https:\/\/ror.org\/036rp1748","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Mycopathologia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Central nervous system (CNS) candidiasis is a rare but life-threatening complication of invasive candidiasis. However, current knowledge derives mainly from isolated case reports, and no comprehensive synthesis has been previously performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a systematic review of published cases of CNS candidiasis. PubMed and Embase were searched without language or date restrictions. Eligible cases required microbiological or histopathological confirmation of\n                      <jats:italic>Candida<\/jats:italic>\n                      spp. and evidence of CNS involvement on cerebrospinal fluid (CSF) analysis or neuroimaging. Demographic, clinical, radiological, laboratory, therapeutic, and outcome data were extracted. We compared mortality and non-mortality groups, paediatric and adult patients, and diagnostic periods.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 418 patients reported between 1945 and 2024 (median age, 21\u00a0years [IQR 0\u201346]; 62% male). Prior antibiotic use (53%), intravascular catheterization (31%), and neurosurgery (22%) were common risk factors. Neuroimaging was abnormal in 87% of cases, and cerebrospinal fluid was abnormal in 96%, typically showing neutrophilic or lymphocytic pleocytosis and low glucose. Nearly half of cases were pediatric (41% of very-low-birth-weight neonates), who more often had healthcare-associated risk factors and less often immunosuppressive conditions. Overall mortality was 35%, mostly within 30\u00a0days; older age was associated with higher mortality, whereas combination antifungal therapy and more recent diagnostic periods were associated with lower mortality in multivariate analysis. Over time, immunosuppression, non-albicans\n                      <jats:italic>Candida<\/jats:italic>\n                      species, and antifungal use increased, while autopsy-based diagnoses and mortality declined.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CNS candidiasis is a rare but severe infection with challenging diagnosis and high mortality, emphasizing the importance of early recognition and appropriate antifungal therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11046-026-01097-y","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T04:21:03Z","timestamp":1787113263000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Characteristics, Diagnosis, and Treatment of Central Nervous System Candidiasis: A Systematic Review of 418 Cases"],"prefix":"10.1007","volume":"191","author":[{"given":"Guilherme Diogo","family":"Silva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariane","family":"Taborda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wdson Luis Lima","family":"Kruschewsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Torioni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariane Cappellini","family":"Stricagnolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo Ferreira","family":"Camilo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isadora Campos","family":"de Sousa Abreu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabela Cristina Oliveira","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine Correia Silva","family":"Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Diniz","family":"Resende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello Mihailenko Chaves","family":"Magri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana Satie Gon\u00e7alves Kono","family":"Magri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Ping","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2097-389X","authenticated-orcid":false,"given":"Vitor Falc\u00e3o","family":"de Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"1097_CR1","doi-asserted-by":"publisher","first-page":"e280","DOI":"10.1016\/S1473-3099(24)00749-7","volume":"25","author":"OA Cornely","year":"2025","unstructured":"Cornely OA, et al. Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM. Lancet Infect Dis. 2025;25:e280\u201393.","journal-title":"Lancet Infect Dis"},{"key":"1097_CR2","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1056\/NEJMra1315399","volume":"373","author":"BJ Kullberg","year":"2015","unstructured":"Kullberg BJ, Arendrup MC. Invasive candidiasis. N Engl J Med. 2015;373:1445\u201356.","journal-title":"N Engl J Med"},{"key":"1097_CR3","doi-asserted-by":"publisher","first-page":"18026","DOI":"10.1038\/nrdp.2018.26","volume":"4","author":"PG Pappas","year":"2018","unstructured":"Pappas PG, Lionakis MS, Arendrup MC, Ostrosky-Zeichner L, Kullberg BJ. Invasive candidiasis. 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JBI critical appraisal checklist for systematic reviews and research syntheses. J Can Health Libr Assoc. 2024;45:180\u20133.","journal-title":"J Can Health Libr Assoc"},{"key":"1097_CR7","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1093\/mmy\/myaa051","volume":"59","author":"H Chaussade","year":"2021","unstructured":"Chaussade H, et al. Central nervous system candidiasis beyond neonates: lessons from a nationwide study. Med Mycol. 2021;59:266\u201377.","journal-title":"Med Mycol"},{"key":"1097_CR8","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1186\/s12879-022-07924-z","volume":"22","author":"H Xiao","year":"2022","unstructured":"Xiao H, et al. Clinical characteristics of central nervous system candidiasis due to Candida albicans in children: a single-center experience. BMC Infect Dis. 2022;22:945.","journal-title":"BMC Infect Dis"},{"key":"1097_CR9","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1080\/00365540310017573","volume":"36","author":"T-L Chen","year":"2004","unstructured":"Chen T-L, et al. Clinical characteristics, treatment and prognostic factors of candidal meningitis in a teaching hospital in Taiwan. Scand J Infect Dis. 2004;36:124\u201330.","journal-title":"Scand J Infect Dis"},{"key":"1097_CR10","doi-asserted-by":"publisher","first-page":"e13767","DOI":"10.1111\/myc.13767","volume":"67","author":"JC Teixeira","year":"2024","unstructured":"Teixeira JC, et al. Association between neuroimaging and clinical outcomes in individuals with central nervous system cryptococcosis. Mycoses. 2024;67:e13767.","journal-title":"Mycoses"},{"key":"1097_CR11","doi-asserted-by":"publisher","first-page":"e13697","DOI":"10.1111\/myc.13697","volume":"67","author":"VF de Oliveira","year":"2024","unstructured":"de Oliveira VF, et al. 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