Negative cerebrospinal fluid β-d-glucan levels as an indicator for treatment cessation ahead of biochemical resolution: A case report of Candida glabrata meningitis

Wee, Liang En; Wong, Crystal Shie Lyeen; Tan, Ai Ling; Oh, Hong Choon

doi:10.1016/j.mmcr.2021.03.003

Cited by 5 publications

(4 citation statements)

References 9 publications

(11 reference statements)

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“…meningitis had some form of immunosuppression, for example, diabetes mellitus, 17 or debilitating hemorrhagic stroke. 18 Immunosuppression caused by treatment with prednisolone in the present case probably contributed to the rapid deterioration of the pre‐existing Candida CNS infection after the first discharge.…”

Section: Discussionmentioning

confidence: 69%

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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Section: Discussionmentioning

confidence: 69%

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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“…There have been case reports of hypercalcemia occurring with azole antifungal use, although cortisol levels were not measured, and it is unclear whether hypocortisolism may have contributed to hypercalcemia ( 36 , 37 ). The authors postulated that hypercalcemia may have occurred due to inhibition of CYP enzymes responsible for the metabolism of vitamin A or via PTH-mediated hypercalcemia.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Hypercalcemia as a manifestation of acute adrenal crisis precipitated by fluconazole use, and a review of the literature

et al. 2023

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Acute adrenal crisis classically presents with vomiting, altered sensorium, and hypotension. We describe a unique case manifesting with severe hypercalcemia. Addisonian crisis was unusually precipitated by fluconazole use. We reviewed other reported cases and discuss the possible mechanisms of hypercalcemia in adrenal insufficiency. This 67-year-old man presented with fever, cough, and vomiting for 1 week and with anorexia and confusion for 3 weeks. He was hypotensive and clinically dehydrated. Investigations revealed left-sided lung consolidation, acute renal failure, and severe non–parathyroid hormone (PTH)–mediated hypercalcemia (calcium, 3.55mol/L; PTH, 0.81pmol/L). Initial impression was pneumonia complicated by septic shock and hypercalcemia secondary to possible malignancy. He received mechanical ventilation; treatment with intravenous fluids, inotropes, and hydrocortisone for septic shock; and continuous renal replacement therapy with low-calcium dialysate. Although hypercalcemia resolved and he was weaned off inotropes, dialysis, and hydrocortisone, his confusion persisted. When hypercalcemia recurred on day 19 of admission, early morning cortisol was <8 nmol/L, with low ACTH level (3.2 ng/L). Other pituitary hormones were normal. Hypercalcemia resolved 3 days after reinstating stress doses of hydrocortisone, and his mentation normalized. On further questioning, he recently received fluconazole for a forearm abscess. He previously consumed traditional medications but stopped several years ago, which may have contained glucocorticoids. He was discharged on oral hydrocortisone. Cortisol levels improved gradually, and glucocorticoid replacement was ceased after 8 years, without any recurrence of hypercalcemia or Addisonian crisis. Both hypercalcemia and adrenal insufficiency may present with similar non-specific symptoms. It is important to consider adrenal insufficiency in hypercalcemia of unclear etiology.

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“…Four case reports and a series of 13 patients with peritoneal dialysis-associated Candida peritonitis described favorable outcomes in patients treated with combination dAmB or liposomal AmB (L-AmB) plus flucytosine (5-FC), a regimen still recommended for treatment of deep-seated Candida infections, e.g., meningitis and endocarditis, based on limited experimental and clinical data. (13,(33)(34)(35)(36)(37) This combination has shown synergy in vitro and is widely used for cryptococcal meningitis (CM). ( 38) Moreover, excellent 5-FC levels are achieved in cerebrospinal fluid (CSF).…”

Section: Invasive Candidiasismentioning

confidence: 99%

CAF to the rescue! Potential and challenges of combination antifungal therapy for reducing morbidity and mortality in hospitalized patients with serious fungal infections

Jacobs,

Chaturvedi

2024

Preprint

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The global burden of invasive fungal disease (IFD) is substantial and escalating. Combination antifungal therapy (CAF) may improve patient outcomes by reducing development of resistance, improving drug penetration and rate of fungal clearance, and allowing for lower, less toxic antifungal drug doses; yet, increased cost, antagonism, drug-drug interactions, and toxicity are concerns. Clinical practice guidelines recommend antifungal monotherapy, rather than CAF, for most IFDs due to a lack of comparative randomized clinical trials. An examination of the existing body of CAF research should frame new hypotheses and determine priorities for future CAF clinical trials. We performed a systematic review of CAF clinical studies for invasive candidiasis, cryptococcosis, invasive aspergillosis, and mucormycosis. Additionally, we summarize findings from animal models of CAF and assess laboratory methods available to evaluate CAF efficacy. Future CAF trials should be prioritized according to animal models showing improved survival and observational clinical data supporting efficacy and safety.

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Negative cerebrospinal fluid β-d-glucan levels as an indicator for treatment cessation ahead of biochemical resolution: A case report of Candida glabrata meningitis

Cited by 5 publications

References 9 publications

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

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

Case Report: Hypercalcemia as a manifestation of acute adrenal crisis precipitated by fluconazole use, and a review of the literature

CAF to the rescue! Potential and challenges of combination antifungal therapy for reducing morbidity and mortality in hospitalized patients with serious fungal infections

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