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First Report of Ventriculoperitoneal Shunt Infection due to Cyberlindnera fabianii
Jonathan Baghdadi1, Peera Hemarajata2, Romney Humphries2
1Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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.
Insights
This study reports the first case of a fungal central nervous system (CNS) infection caused by Cyberlindnera fabianii in an immunocompetent adult with a ventriculoperitoneal (VP) shunt. It highlights transient fungemia as a potential risk factor for invasive fungal CNS disease.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Fungal central nervous system (CNS) infections carry high morbidity and mortality.
- The role of transient fungemia in immunocompetent individuals with ventriculoperitoneal (VP) shunts leading to CNS infections is not well-established.
- Cyberlindnera fabianii CNS infections are rare, with limited data on their clinical presentation, diagnosis, and treatment.
Purpose of the Study:
- To report the first documented case of CNS infection caused by Cyberlindnera fabianii in an immunocompetent adult with a VP shunt.
- To explore the potential mechanism of infection, including spontaneous translocation of yeast from the gastrointestinal tract.
- To discuss the implications for diagnosis and management of such rare fungal CNS infections.
Main Methods:
- Case report of an immunocompetent adult with a VP shunt who developed meningitis.
- Identification of Cyberlindnera fabianii as the causative agent.
- Analysis of potential sources of infection, including dietary factors.
Main Results:
- A case of meningitis due to Cyberlindnera fabianii in an immunocompetent adult with a VP shunt is described.
- Ingestion of fermented products was identified as a potential source for yeast translocation into the VP shunt system.
- The patient experienced CNS infection despite having no other apparent risk factors for fungemia.
Conclusions:
- Transient fungemia can lead to invasive fungal CNS disease in immunocompetent hosts with VP shunts, even without other risk factors.
- Long-term antifungal therapy is crucial, especially when complete VP shunt removal is not feasible.
- This case underscores the importance of considering fungal etiologies in VP shunt infections, even in immunocompetent patients.
