Candida tropicalis as an emerging pathogen in Candida meningitis: case report and review

Abstract

We declare no confl ict of interest. ABSTRACTCandida species are an uncommon cause of meninigitis. Given the rarity of this infection, the epidemiology, prognosis, and optimal therapy for Candida meningitis are poorly defi ned. The authors report on a paraplegic patient due to spinal cord injury who developed C. tropicalis meningitis. In addition, we review and discuss other reported cases of C. tropicalis meningitis in the medical literature.

Case Report: Candida dubliniensis as a Cause of Chronic Meningitis

“…Risk factors for invasive candidiasis include neurosurgical interventions, previous treatment with antibiotics, parenteral nutrition, abdominal surgery, and an immunocompromised state such as HIV/AIDS, malignancy, or chronic steroid use (13,14). Increasingly, non-C. albicans etiologies of meningitis have been reported, like C. tropicalis, C. parapsilosis, and C. glabrata (14)(15)(16)(17)(18).…”

“…In invasive candidiasis, including candidal meningitis, species identification and azole resistance testing are critical in order to identify the optimal antifungal therapy as antifungal resistance profiles vary by Candida species. Although specific Candida species are associated with unique risk factors [C. tropicalis with head and neck surgery (18), C. parapsilosis with medical devices and catheters (17), C. glabrata with the urogenital tract (19), etc. ], diagnosing Candida as a cause of chronic meningitis requires a high level of suspicion in the setting of negative CSF bacterial cultures.…”

Magnetic Resonance Imaging Features of Tropical Candidal Meningoencephalitis

“…Although the patient’s serum and CSF were positive for anti-NMDAR antibodies, this patient’s disease was not diagnosed as anti-NMDAR autoimmune encephalitis because she did not show the typical clinical symptoms of this type of disease . At present, there is no best-known treatment for intracranial tropical Candida infection and the disease carries high mortality . The patient received triple antifungal therapy for 1 month during hospitalization and continued to take 2 antifungal drugs (oral fluconazole and fluorocytosine) for 1 month after being discharged.…”

Fungal Infections of the Central Nervous System

“…C. albicans is the species implicated in most CNS infections, but other species such as Candida tropicalis, Candida lusitaniae, and Candida parapsilosis occasionally produce CNS disease. [71][72][73][74][75] In the normal host, Candida rarely causes deepseated infections. Factors that can encourage spread of Candida from mucosal surfaces to deeper tissues, such as the subarachnoid space, include prematurity, broad-spectrum antibacterial therapy, hyperalimentation, malignancy, indwelling catheters, treatment with corticosteroids, neutropenia, abdominal surgery, diabetes mellitus, burns, and intravenous drug use.…”