Modifying cerebral candidiasis by altering the infectious entry route

Diffuse leptomeningitis did not occur in healthy adult male Wistar rats with transient candidemia produced by the injection of organisms into the internal carotid artery, even though intraparenchymal microabscesses with yeasts and pseudohyphae were seen throughout the brain. Candida albicans was culturally identified in the brain and kidney. Injecting the organisms into the cisterna magna caused an infection characterized by lymphocytes and histiocytes and was confined to the leptomeninges. In this meningeal model, fungi were recovered only from the CNS. The overwhelming prevalence at autopsy of cerebral candidal microabscesses without diffuse leptomeningitis is apparently due to transient candidemia. Meningitis due to candidemia is rare and seems to require a microabscess that is accessible to the circulating CSF. This latter event is a late and overwhelming feature of cerebral candidiasis.