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Chronic neutrophilic meningitis caused by Candida albicans
M M del Pozo1, F Bermejo, J A Molina
1Servicios de Medicina Interna y Neurología, Hospital Universitario, Madrid.
Abstract:
Meningitis caused by Candida albicans is a very infrequent entity. We present 3 intravenous drug users with chronic neutrophilic meningitis caused by Candida albicans. The clinical, microbiological and radiological features of the 3 patients are reviewed. The interval between the onset of the disease and the diagnosis was long (from 4 to 12 months). Candida albicans was cultured from cerebrospinal fluid (CSF) in the 3 patients. All of them developed hydrocephalus, meanwhile arachnoiditis was disclosed in two. The therapy with amphotericyn, 5-flucytosine and fluconazole produced clinical improvement and the sterilisation of the CSF in all the 3 cases. Clinicians should be aware of this entity because of diagnosis may be delayed in several months.
Insights
Candida albicans meningitis is rare, particularly in intravenous drug users. Early diagnosis and treatment are crucial for managing this serious fungal infection, even with delayed recognition.
Area of Science:
- Infectious Diseases
- Mycology
- Neurology
Background:
- Candida albicans meningitis is an exceptionally rare clinical entity.
- Intravenous drug use is a potential risk factor for opportunistic infections.
Observation:
- Three cases of chronic neutrophilic meningitis caused by Candida albicans in intravenous drug users are presented.
- Patients experienced prolonged diagnostic delays, ranging from 4 to 12 months.
- Cerebrospinal fluid (CSF) cultures confirmed Candida albicans in all three patients.
Findings:
- All patients developed hydrocephalus, and two had arachnoiditis.
- Combination antifungal therapy (amphotericin, 5-flucytosine, fluconazole) led to clinical improvement.
- Antifungal treatment resulted in cerebrospinal fluid (CSF) sterilization in all cases.
Implications:
- This case series highlights the importance of considering Candida albicans meningitis in at-risk populations.
- Delayed diagnosis is common, underscoring the need for increased clinical awareness.
- Prompt and appropriate antifungal therapy can effectively manage this severe fungal meningitis.