[Candidiasis]

CNS candidiasis typically occurs in patients with candidemia, especially immunocompromised hosts or patients with neurosurgical CNS devices. The gold standard for diagnosis is identification of Candida growth in CSF culture. For initial treatment, liposomal amphotericin B with or without flucytosine is recommended. If the isolate is susceptible to initial treatment, fluconazole is added. When possible, CNS devices should be removed. Autosomal recessive CARD9 deficiency is a primary immunodeficiency disorder associated with chronic mucocutaneous or invasive candidiasis, especially drug-resistant or recurrent candidal meningitis. In patients presenting with primary candidal meningitis in the absence of known immunodeficiency, CARD9 deficiency should be considered. A history of chronic mucocutaneous candidiasis provides an important diagnostic clue.