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Recurrent Candida tropicalis meningitis
Nancy L Dawson1, Hector A Robles, Salvador Alvarez
1Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.
Abstract:
Candida meningitis, a previously rare occurrence, has been increasing in prevalence and often is a result of complications of neurosurgery. We describe the case of a 49-year-old man who presented with headache, vertigo, intermittent blurred vision, and multiple episodes of nausea and vomiting. Computed tomography (CT) showed a left cerebellar hemorrhage with obliteration of the fourth ventricle causing hydrocephalus. He had an occipital craniotomy with transcondylar evacuation of the hemorrhage and placement of a temporary ventriculostomy. The hospital stay was prolonged because of postsurgical complications, and Candida tropicalis meningitis developed. Treatment was started with 400 mg of fluconazole administered intravenously every 12 h. In vitro susceptibility testing showed a minimum inhibitory concentration (MIC) to fluconazole of 1 microg/mL. Fluconazole was therefore continued orally for a total of 60 days, and the patient remained asymptomatic for 2 years. He then presented with increased vertigo and ataxia. Cerebrospinal fluid cultures grew C. tropicalis, which again showed susceptibility to fluconazole with a MIC of 1 microg/mL, identical to that in the previous infection. However, a second course of fluconazole failed to control the infection despite adequate cerebrospinal fluid levels.
Insights
Candida tropicalis meningitis, a complication of neurosurgery, can recur despite initial fluconazole treatment. This case highlights potential treatment failure even with susceptible fungal strains.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Mycology
Background:
- Candida meningitis is an emerging complication following neurosurgical procedures.
- Increasing prevalence necessitates understanding treatment challenges and outcomes.
Observation:
- A 49-year-old male developed Candida tropicalis meningitis post-neurosurgery.
- Initial fluconazole treatment was successful for two years.
Findings:
- Recurrent Candida tropicalis meningitis occurred despite documented in vitro susceptibility to fluconazole (MIC 1 µg/mL).
- A second course of fluconazole failed to eradicate the infection, indicating treatment failure.
Implications:
- This case underscores the potential for fluconazole treatment failure in recurrent Candida meningitis.
- Further research is needed to explore alternative or adjunctive therapies for resistant or relapsing cases.
