Post-COVID-19 neurocandidiasis

Area of Science:

• Infectious Diseases
• Mycology
• Neurology

Background:

• Neurocandidiasis is a severe, often fatal, central nervous system infection caused by Candida species.
• It primarily affects severely immunocompromised individuals, particularly those with recent antibiotic or corticosteroid use.
• Risk factors include invasive procedures, indwelling devices, and prolonged hospitalization.

Observation:

• A 70-year-old male, admitted to the ICU for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, developed fever, coma, and multifocal neurological deficits 13 days post-extubation.
• Candida albicans was isolated from urine and blood cultures.
• Brain MRI revealed multiple gadolinium-enhanced ring lesions, suggestive of abscesses or inflammation.

Findings:

• The patient was diagnosed with neurocandidiasis based on clinical presentation, microbiological findings, and neuroimaging.
• Aggressive antifungal therapy was initiated promptly.
• Despite treatment, the patient developed hospital-acquired pneumonia and ultimately succumbed to the infection.

Implications:

• This case underscores the critical need for high clinical suspicion for neurocandidiasis in immunocompromised patients presenting with neurological deterioration.
• Early diagnosis and aggressive antifungal treatment are crucial, but outcomes remain challenging, especially in critically ill patients.
• The potential for invasive fungal infections like neurocandidiasis in the context of viral pneumonia and intensive care unit stays warrants further investigation.