Abstract
Candida meningitis in neurosurgical patients is relatively unusual but is associated with a high mortality rate. We present our experience with this infection and discuss the clinical characteristics, treatment options and outcomes. We retrospectively reviewed neurosurgical patients with multiple positive cerebrospinal fluid (CSF) culture results in our hospital from January 2013 to December 2019. Nine patients were available for review according to our inclusion and exclusion criteria. Four species of Candida were isolated from the CSF samples and Candida albicans accounted for half of all infections. Eight infections were associated with ventricle peritoneal shunt, lumbar cistern peritoneal shunt or external ventricular drain. All of these foreign intracranial materials were removed or changed and all the patients received antifungal treatment, including fluconazole and/or voriconazole. It is associated with severe long-term outcomes in survivors and a mortality rate that reaches 11.1%. Prior treatments with broad-spectrum and high-grade antibiotics and anaemia are possible risk factors for Candida meningitis. We advise that foreign intracranial material should be removed or changed as early as possible and the timing of re-shunt operation can be 1 month after control of Candida meningitis has been achieved, with several negative CSF culture results.
Highlights
While it is estimated that 1.5 million fungal species exist, only approximately 70 000 have been formally described
Patients with neurological diseases, who needed neurosurgical intervention, with clinical symptoms of central nervous system (CNS) infection and positivity of at least two cerebrospinal fluid (CSF) cultures for Candida species were included in the study
In the series of 24 patients with Candida in CSF cultures, two patients had no history of neurosurgery and seven patients had no signs and symptoms of meningitis
Summary
While it is estimated that 1.5 million fungal species exist, only approximately 70 000 have been formally described. 300 may be pathogenic in humans and only 10–15% of this influence the central nervous system (CNS) [1, 2]. Fungal CNS infections can be broadly divided into those that infect a healthy host (Cryptococcus, Coccidioides, Histoplasma, Blastomyces, Sporothrix spp.) and those that cause opportunistic infections in an immunocompromised host (Candida, Aspergillus, Zygomycetes, Trichosporon spp.) [1, 3]. The incidence of fungal infections of the CNS has been increasing. CNS fungal infections can present as meningitis, meningoencephalitis, brain abscesses, or stroke syndrome due to vascular invasion [4, 5]. Based on the hospital discharge data, fungal infections accounted for 2.7% of cases of meningoencephalitis in the USA between 2011 and 2014 [6]
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