Device-associated Central Nervous System Infection Caused by Candida parapsilosis

Area of Science:

• Neuroscience
• Infectious Diseases
• Medical Mycology

Background:

• Hydrocephalus in infants often requires cerebrospinal fluid (CSF) diversion, utilizing devices like shunts or drains that are susceptible to infection.
• Device-associated central nervous system (CNS) infections pose diagnostic challenges due to nonspecific symptoms.

Observation:

• A six-month-old infant presented with hydrocephalus and subsequently developed a fever and blocked external ventricular drain (EVD).
• Infection with pan-susceptible Candida parapsilosis was confirmed in the CSF, despite initial broad-spectrum antibiotics.
• Treatment involved surgical intervention, placement of an Ommaya reservoir for targeted antibiotic delivery, and antifungal therapy with fluconazole.

Findings:

• Despite initial treatment, Candida parapsilosis persisted in the CSF for 10 days.
• Interventricular antibiotic administration via an Ommaya reservoir led to sterile CSF by day 13.
• The infant ultimately received a ventriculoperitoneal shunt after a full course of antifungal therapy.

Implications:

• This case highlights Candida parapsilosis as an emerging pathogen in device-associated CNS infections, particularly in vulnerable infant populations.
• Increased prevalence of C. parapsilosis necessitates heightened clinical suspicion for this fungal pathogen in infants with CNS device infections.
• Prompt diagnosis and appropriate antifungal management, potentially including targeted delivery methods, are vital for favorable outcomes in CNS candidiasis.