Case Report: Candida dubliniensis as a Cause of Chronic Meningitis

Tahir, Madiha; Peseski, Andrew M.; Jordan, Stephen J.

doi:10.3389/fneur.2020.601242

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…In the workup of chronic meningitis, Aspergillus infection should be strongly considered in patients with IVDU and HCV co-infection. Risk factors for fungal meningitis, in the absence of other causes of clear compromise to cellular immunity, have been suggested to include drug addition, chronic alcoholism, hepatic failure [16,17], as well as HCV co-infection [18,19]. Our report supports that together, both IVDU and HCV can increase the risk for the development of fungal or Aspergillus meningitis.…”

Section: Discussionsupporting

confidence: 77%

Diagnostic Dilemma of Aspergillus Meningitis in Patients With Hepatitis C Virus Co-Infection: A Case Series

Seemiller

Malik

2022

J Neurol Res

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Aspergillus meningitis can occur in immunocompromised and immunocompetent patients. The diagnostic yield is only 39% in immunocompromised patients and 69% in immunocompetent patients. Diagnosis can be challenging, as repeated cerebrospinal fluid (CSF) cultures can be negative. Even with multiple cultures, the diagnostic yield is meager, sometimes requiring a tissue diagnosis. However, prompt recognition and treatment initiation are crucial to minimize morbidity. We present two cases of patients with a history of intravenous drug use disorder (IVDU) co-infected with hepatitis C virus (HCV) and Aspergillus. Two young Caucasian patients with untreated HCV infection and a history of IVDU, presented with fevers and headaches. Their imaging and multiple CSF samples showing pleocytosis with negative fungal cultures led to a diagnostic dilemma. Due to progressive decline and to ascertain a definitive diagnosis, a brain biopsy resulted in a tissue diagnosis of fungal meningitis secondary to Aspergillus, with hyphae and granulomas, in both individuals. In the workup of chronic meningitis, Aspergillus infection should be strongly considered in patients with IVDU and HCV co-infection. In patients with chronic meningitis lacking definitive diagnosis from spinal fluid, tissue sampling should be pursued as soon as possible to ensure rapid treatment and prevent disability. HCV is associated with a reduction in cellular immunity; our two cases support that HCV and a history of IVDU carry risks of immunosuppression, warranting early and expedited workup for chronic fungal meningitis.

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Section: Discussionsupporting

confidence: 77%

Diagnostic Dilemma of Aspergillus Meningitis in Patients With Hepatitis C Virus Co-Infection: A Case Series

Seemiller

Malik

2022

J Neurol Res

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“…However, we found a decreased abundance of C. dubliniensis and C. glabrate was associated with clinical Rm after capsulized FMT . C. dubliniensis is phenotypically similar to C. albicans and is increasingly recognized as an opportunistic pathogenic fungus in immunocompromised hosts ( Gutierrez et al., 2002 ; Jewtuchowicz et al., 2008 ; Yamahiro et al., 2016 ; Tahir et al., 2020 ). C. albicans can break through the mucosal barrier and induce an intestinal immune response related to UC pathogenesis ( Naglik et al., 2011 ; Romani, 2011 ).…”

Section: Discussionmentioning

confidence: 99%

Specific fungi associated with response to capsulized fecal microbiota transplantation in patients with active ulcerative colitis

Chen

Fan

Zhang

et al. 2023

Front. Cell. Infect. Microbiol.

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ObjectiveFecal microbiota transplantation (FMT) is a novel microbial treatment for patients with ulcerative colitis (UC). In this study, we performed a clinical trial of capsulized FMT in UC patients to determine the association between the gut fungal community and capsulized FMT outcomes.DesignThis study recruited patients with active UC (N = 22) and healthy individuals (donor, N = 9) according to the criteria. The patients received capsulized FMT three times a week. Patient stool samples were collected before (week 0) and after FMT follow-up visits at weeks 1, 4, and 12. Fungal communities were analysed using shotgun metagenomic sequencing.ResultsAccording to metagenomic analysis, fungal community evenness index was greater in samples collected from patients, and the overall fungal community was clustered among the samples collected from donors. The dominant fungi in fecal samples collected from donors and patients were Ascomycota and Basidiomycota. However, capsulized FMT ameliorated microbial fungal diversity and altered fungal composition, based on metagenomic analysis of fecal samples collected before and during follow-up visits after capsulized FMT. Fungal diversity decreased in samples collected from patients who achieved remission after capsulized FMT, similar to samples collected from donors. Patients achieving remission after capsulized FMT had specific enrichment of Kazachstania naganishii, Pyricularia grisea, Lachancea thermotolerans, and Schizosaccharomyces pombe compared with patients who did not achieve remission. In addition, the relative abundance of P. grisea was higher in remission fecal samples during the follow-up visit. Meanwhile, decreased levels of pathobionts, such as Candida and Debaryomyces hansenii, were associated with remission in patients receiving capsulized FMT.ConclusionIn the metagenomic analysis of fecal samples from donors and patients with UC receiving capsulized FMT, shifts in gut fungal diversity and composition were associated with capsulized FMT and validated in patients with active UC. We also identified the specific fungi associated with the induction of remission. ClinicalTrails.gov (NCT03426683).

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“…4 Patients predisposed to Candida spp. infections of the CNS are preterm infants and neonates with an immature immune system, patients immunosuppressed by HIV, hepatitis C and heroin addiction, neutropenic patients, patients receiving immunosuppression after organ transplantation and chemotherapy for malignancies, [4][5][6][7][8][9][10][11] and patients after neurosurgery. 12 The most frequent species isolated is C. albicans, but other species including C. tropicalis, C lusitaniae, and C. dubliniensis can also cause meningitis.…”

Section: Case Presentationmentioning

confidence: 99%

Chronic Candida albicans meningitis misdiagnosed as polymyalgia rheumatica and successfully treated with voriconazole

Giotaki

Groß

Lange

et al. 2022

Clinical Case Reports

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The outcome of chronic meningitis depends to a large degree on the causative pathogen and the interval between onset of symptoms and diagnosis. We present a patient with a delayed diagnosis and several complications, for whom adequate therapy resulted in a favorable outcome. In a 76‐year‐old male patient, Candida albicans meningitis was diagnosed 4 months after the onset of symptoms. CSF findings (protein >1000 mg/L, predominance of intrathecal immunoglobulin A synthesis, lactate concentrations of approx. 10 mmol/L, leukocyte counts around 1000/μl, variable differential leukocyte counts) resembled tuberculous meningitis. In spite of the long interval without treatment, voriconazole 200 mg every 12 h for 7 weeks followed by fluconazole 300 mg/day maintenance therapy for 7 months led to a recovery with only mild deficits. The case illustrates that 1. C. albicans can cause chronic meningitis in patients without severe immune defects, 2. patients can survive C. albicans meningitis with mild long‐term sequelae even when diagnosis and adequate treatment are delayed, and 3. voriconazole as a sole agent may be suitable for treatment of C. albicans meningitis.

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Case Report: Candida dubliniensis as a Cause of Chronic Meningitis

Cited by 10 publications

References 22 publications

Diagnostic Dilemma of Aspergillus Meningitis in Patients With Hepatitis C Virus Co-Infection: A Case Series

Diagnostic Dilemma of Aspergillus Meningitis in Patients With Hepatitis C Virus Co-Infection: A Case Series

Specific fungi associated with response to capsulized fecal microbiota transplantation in patients with active ulcerative colitis

Chronic Candida albicans meningitis misdiagnosed as polymyalgia rheumatica and successfully treated with voriconazole

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