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Recurrent Candida albicans Ventriculitis Treated with Intraventricular Liposomal Amphotericin B
Demet Toprak1, Sevliya Öcal Demir1, Eda Kepenekli Kadayifci1
1Department of Pediatrics, Marmara University School of Medicine, 3500 Istanbul, Turkey.
Abstract:
Central nervous system (CNS) infection with Candida is rare but significant because of its high morbidity and mortality. When present, it is commonly seen among immunocompromised and hospitalized patients. Herein, we describe a case of a four-year-old boy with acute lymphoblastic leukemia (ALL) who experienced recurrent Candida albicans meningitis. The patient was treated successfully with intravenous liposomal amphotericin B at first attack, but 25 days after discharge he was readmitted to hospital with symptoms of meningitis. Candida albicans was grown in CFS culture again and cranial magnetic resonance imaging (MRI) showed ventriculitis. We administered liposomal amphotericin B both intravenously and intraventricularly and favorable result was achieved without any adverse effects. Intraventricular amphotericin B may be considered for the treatment of recurrent CNS Candida infections in addition to intravenous administration.
Insights
Recurrent central nervous system (CNS) Candida infections in children with acute lymphoblastic leukemia (ALL) can be challenging. Intraventricular amphotericin B, alongside intravenous administration, offers a potential treatment for these severe cases.
Area of Science:
- Infectious Diseases
- Pediatric Oncology
- Neurology
Background:
- Central nervous system (CNS) infections caused by Candida species are rare but associated with high morbidity and mortality.
- These infections predominantly affect immunocompromised individuals, particularly those hospitalized.
- Recurrent cases pose significant treatment challenges.
Purpose of the Study:
- To report a case of recurrent Candida albicans meningitis and ventriculitis in a pediatric patient with acute lymphoblastic leukemia (ALL).
- To evaluate the efficacy and safety of combined intraventricular and intravenous liposomal amphotericin B in treating recurrent CNS Candida infection.
Main Methods:
- A four-year-old boy with ALL diagnosed with recurrent Candida albicans meningitis.
- Treatment involved initial intravenous liposomal amphotericin B, followed by combined intravenous and intraventricular liposomal amphotericin B for the recurrent episode.
- Cerebrospinal fluid (CFS) cultures and cranial magnetic resonance imaging (MRI) were used for diagnosis and monitoring.
Main Results:
- The patient experienced a relapse of Candida albicans meningitis and ventriculitis after initial treatment.
- Combined intraventricular and intravenous liposomal amphotericin B administration resulted in a favorable outcome.
- No adverse effects were observed during the combined treatment regimen.
Conclusions:
- Recurrent CNS Candida infections in immunocompromised pediatric patients require aggressive management.
- Intraventricular administration of liposomal amphotericin B, in conjunction with intravenous therapy, is a viable and safe option for treating recurrent CNS Candida infections.
- This approach may improve outcomes in challenging cases of pediatric fungal meningitis.
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