Clinical and microbiological characteristics of Candida meningitis/ventriculitis in children
Abstract
Background: Candida meningitis/ventriculitis is rather rare during childhood. In this study, we investigated the clinical characteristics, risk factors, treatment, and prognosis of patients with Candida meningitis/ventriculitis.
Methods: Patients under the age of 18 years who were diagnosed with Candida meningitis/ventriculitis were evaluated retrospectively.
Results: A total of 10 cases with Candida meningitis/ventriculitis were analyzed. Three patients (30%) were below the age of one, and two (20%) were neonates. The two most common underlying conditions were hydrocephalus shunt and prematurity. Predisposing factors were a history of broad-spectrum antibiotic use, external ventricular drainage, total parenteral nutrition, central venous catheter, and staying in intensive care. The cerebrospinal fluid culture was positive in all patients, and 10% (1/1) had bacteremia. Of the isolates, 50% were C. albicans, 30% were C. tropicalis, 10% were C. lusitaniae, and 10% were C. dubliniensis. Fluconazole treatment was initiated in four (40%) and voriconazole in three (30%) patients. Two patients received combined treatment (amphotericin B + fluconazole/voriconazole). The median treatment duration was 38.6 days (range: 16–70 days). Three patients received intraventricular Amphotericin B.Central nervous system devices which were assumed to be infected were removed. A complication of endophthalmitis developed in one patient. The mortality rate was 10%.
Conclusions: Among agents causing meningitis/ventriculitis, Candida should also be kept in mind in premature neonates and patients with ventricular-peritoneal shunts. The history of antibiotic use and external ventricular drainage are important predisposing factors. It can be successfully treated with fluconazole, voriconazole, amphotericin B, and removal of the central nervous system device.
Keywords
Candida , Ventriculitis , Meningitis , Treatment , Children.
References
- 1. Kauffman CA. Candida infections of the central nervous system [updated 26 Apr 2022. Available at: https://www.uptodate.com/ contents/candida-infections-of-the-central-nervous-system?search= Candida-infections-of-the-central-nervoussystem&source=search_ result&selectedTitle=1~150&usage_type=default&display_rank=1. Accessed July 22, 2022
- 2. Campbell JR, Palazzi DL. Candida infections in children [updated 12 Nov 2019. Available at: https://www.uptodate.com/ contents/ candida-infections-in-children?search=%20Candida%20 %E2%80%93infections-%20in%20-children.&source=search_ result&selectedTitle=1~150&usage_type=default&display_rank=1.
- 3. Romero J, Jacobs R. Fungal Meningitis. In: Cherry J HG, Kaplan SL,Steinbach WJ, Hotez PJ, editor. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia: Elsevier; 2019. p.345-9.
- 4. Cohen-Wolkowiez M, Smith PB, Mangum B, Steinbach WJ, Alexander BD, Cotten CM, et al. Neonatal Candida meningitis: significance of cerebrospinal fluid parameters and blood cultures. J Perinatol. 2007 Feb;27(2):97-100.
- 5. Prevention CfDCa. Fungal Meningitis Available at: https://www. cdc.gov/FungalMeningitis/about.html/detail/namingthe-Parasites. Accessed July 22, 2022
- 6. Sánchez-Portocarrero J, Pérez-Cecilia E, Corral O, Romero-Vivas J, Picazo JJ. The central nervous system and infection by Candida species. Diagn Microbiol Infect Dis. 2000;37(3):169-79.
- 7. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky- Zeichner L, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1-50.
- 8. Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM, et al. 2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017;64(6):e34-e65.
- 9. Arisoy ES, Arisoy AE, Dunne WM, Jr. Clinical significance of fungi isolated from cerebrospinal fluid in children. Pediatr Infect Dis J. 1994;13(2):128-33.
- 10. Bilgin E, Ökten A, Gezercan Y, Çavuş G, Açık V, Arslan A, et al. Pediatric Giant Cerebral Candida Abscess: A Case Report. Pediatr Neurosurg. 2019;54(3):207-211.