First Report of Ventriculoperitoneal Shunt Infection due toCyberlindnera fabianii

Abstract

Fungal infections in the central nervous system (CNS) are associated with significant morbidity and death. Transient fungemia in immunocompetent patients without any other risk factors for fungemia has been suggested as a possible mechanism that may lead to serious fungal ventriculoperitoneal (VP) shunt infections, but evidence is lacking. The clinical spectrum, diagnosis, and optimal therapy of Cyberlindnera fabianii infections remain to be determined. We describe the first case of CNS infection due to C. fabianii that occurred in an immunocompetent adult with a VP shunt. Spontaneous translocation with yeast that is not part of the normal gastrointestinal flora in the setting of ingestion of multiple servings of a fermentation product was the likely source from which Cyberlindnera fabianii gained entrance into the VP shunt system, causing meningitis in this patient. The authors conclude that, in view of the high morbidity associated with yeast infection of the CNS, long-term antifungal therapy should be strongly considered in cases where the VP shunt cannot be completely removed. Transient fungemia may lead to invasive disease in an immunocompetent host with VP shunt, even in the absence of any other risk factors for fungemia and even after remote placement of the VP shunt.

Identification and Antifungal Susceptibility Profiles of Cyberlindnera fabianii in Korea

“…According to our results of API 20 C and Vitek 2 using eleven isolates of Cy. fabianii, two isolates were identified as Candida utilis and the rests of them were Candida pelliculosa (Table 1), which was consistent with the study of Baghdadi et al [14]. That study revealed that Vitek 2 with ID 32 C system misidentified Cy.…”

“…Catheterrelated blood infections caused by Cy. fabianii have already been reported in several case studies [4,14]. Kaur et al [25] also mentioned that the frequent use of central venous catheters, urinary catheters, and prosthetic devices lead to a high risk infection of Candida species.…”

“…Although human infections caused by Cy. fabianii were known to be extremely rare [13,14], case reports of fungal infections caused by Cy. fabianii have been recently increasing worldwide including China, Croatia, India, USA and South Korea.…”

Cyberlindnera fabianii fungaemia outbreak in preterm neonates in Kuwait and literature review

“…Among these emerging Candida spp., C. fabianii (anamorph Candida fabianii) is one such species, which exhibits reduced susceptibility to fluconazole, itraconazole and posaconazole . Until September 2017, 21 patients with C. fabianii infection (including 14 patients with fungaemia) have been reported from different countries across Asia (n = 6), Europe (n = 12) and America (n = 3) (Table ) . Similar to our study, nearly half of these cases also occurred in paediatric age group, mostly including neonates (n = 7).…”

“…Amphotericin B was used in 10 patients, mostly including those in whom the initial response to azoles was unsatisfactory . In a series of six cases from Croatia, fluconazole was used as a primary therapy followed by caspofungin in two cases and amphotericin B in one case . All the patients responded favourably with cultures becoming negative between 15 and 40 days following therapy .…”