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SHORT COMMUNICATION
Year : 2007  |  Volume : 2  |  Issue : 2  |  Page : 90-91
 

Meningitis caused by Candida albicans in a premature neonate


Department of Microbiology, Lokmanya Tilak Municipal Medical College, Sion, Mumbai - 400 022, Maharashtra, India

Correspondence Address:
Vasant P Baradkar
Department of Microbiology, 4th Floor, College Building, Lokmanya Tilak Municipal Medical College, Sion, Mumbai - 400 022
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1817-1745.36773

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How to cite this article:
Baradkar VP, Taklikar SM. Meningitis caused by Candida albicans in a premature neonate. J Pediatr Neurosci 2007;2:90-1

How to cite this URL:
Baradkar VP, Taklikar SM. Meningitis caused by Candida albicans in a premature neonate. J Pediatr Neurosci [serial online] 2007 [cited 2020 Sep 23];2:90-1. Available from: http://www.pediatricneurosciences.com/text.asp?2007/2/2/90/36773



   Introduction Top


The candidial infection of the CNS is an uncommon manifestation of the disseminated infection due to the Candida species. It usually occurs in immunocompromized patients, namely, [1] in patients treated with broad spectrum antibiotics in association with intravenous hyperalimentation, following the surgical manipulation of the mucosal surface colonized with the candida species or following the neurosurgical procedure. [2],[3]

Among the neonates, candida meningitis is one of the most common manifestation of neonatal invasive candidiasis. [3],[4],[5] The most common species reported is Candida albicans . Other species reported are Candida tropicalis and Candida parapsilosis . In this study, we report a case of candidial meningitis in a premature neonate admitted to the neonatal intensive care unit (NICU).


   Case History Top


A premature male neonate with a gestational age of 26 weeks and birth weight of 1800 g was admitted in Neonatal Intensive Care Unit with fever and respiratory distress syndrome. He was started on broad spectrum antibiotics for seven days. The fever continued and on the seventh day, the neonate developed neurological clinical signs of increased intracranial pressure; bulging fontanelle and vomiting. CSF showed pleocytosis, 500 cells/cu.mm . with lymphocyte predominance and low glucose level with increased proteins (80 mg/dl). The Gram stain of the CSF showed only the presence of pus cells without any pathogen. The culture of CSF did not reveal any organisms. As signs of sepsis were present and CSF findings were in favour of meningitis, the clinicians sent blood, urine for fungal culture. The samples were inoculated on Sabouraud's Dextrose Agar (SDA) slants, blood agar and chocolate agar. From the blood cultures, creamish white colonies were observed over the entire media after incubation at 37C overnight. The organism was identified as yeast on the preparation of smear from the media. The isolate was further identified as Candida albicans by the positive Germ tube test, typical spider-like growth on corn meal agar with regular distribution of the clusters of blastoconidia at regular intervals and sugar assimilation tests. Urine culture did not grow any pathogen. Based on the clinical suspicion, CSF abnormalities and isolation of C. albicans from the blood specimens, Amphotericin B was started. The patient responded to this antifungal treatment and was discharged.


   Discussion Top


Candidial meningitis is more common in neonates and is one of the most common manifestation of the invasive candidiasis. [3],[4],[5] Little information is available on long-term neuro-development of premature neonates with invasive candidial infections.

Meningeal candidiasis produces alternations in CSF and it is very similar to those observed with other infections such as tuberculosis, cryptococcosis and histoplasmosis. Gram staining of the CSF is positive in only 30% cases. Moreover, difficulties in growing candida species from CSF have been reported. [4],[6],[7] Similar findings were observed in this study.

The criteria for diagnosis of candidial meningitis as suggested by Casado et al . [8] were are follows: (1) isolation of the candida species in the CSF culture or histopathologic evidence of candida in the meningeal tissue; (2) clinical and CSF findings that are suggestive of meningitis in addition to presence of systemic candidiasis were diagnosed by yeast from the extra-cranial site and the clinical CSF improvement due to the antifungal treatment and exclusion of other pathogens. In our case, the second criterion is satisfied, and hence, the diagnosis of candidial meningitis is confirmed. It has been suggested that a physician dealing with sepsis in a neonate should suspect candida meningitis if Candida species were recovered from blood, urine or other sites that are suggestive of heavy colonization. [5] In the present case, no colonization at the mucosal sites was detected. Candida colonization may occur early in life. From those sites, the pathogen may spill over and cause candidial septicaemia. Prematurity, low birth weight and respiratory distress syndrome are the common predisposing factors for candidemia, which probably led to Candida septicaemia in our case.

Candida meningitis may complicate systemic candidiasis in a premature neonate. In a 10-year study of candidial meningitis by Fernandez M et al. , [9] 33 out of the 106 neonates had candidial meningitis and the disease was commonly manifested by respiratory decompensation. Findings of CSF analysis varied; pleocytosis was inconsistent, gram staining was consistently negative. The similar scenario occurred with the present case.

In conclusion, the initial clinical features of candidial meningitis are indistinguishable from those of other causes of systemic infections in premature infants. A high index of suspicion is required to diagnose so that an early and timely intervention with amphotericin B can reduce the mortality.

 
   References Top

1.Amstrong D, Wong B. Central nervous system infections in immunocompromized hosts. Ann Rev Med 1982;33:293-308  Back to cited text no. 1    
2.Rubin RH, Hooper DC. Central nervous system infections in the compromised host. Med Clin North Am 1958;69:281-96.  Back to cited text no. 2    
3.Baley JE, Kliegman TM, Fanaroft AA. Disseminated fungal infections in very low birth weight infants: Clinical manifestations and epidemiology. Pediatrics 1984;73:144-52.  Back to cited text no. 3    
4.Chesney PJ, Justman RA, Bogdanowica WM. Candida meningitis in newborn infants: A review and report of Combined amphotericin B and flucytosine therapy. Johns Hopkins Med J 1978;142:155-60.  Back to cited text no. 4    
5.Faix RG. Systemic candida infections in infants in intensive care nurseries: High incidence of central nervous system involvement. J Pediatr 1984;105:616-22.  Back to cited text no. 5  [PUBMED]  
6.Voice RA, Bradley SF, Sangeorzan JA, Kauffman CA. Chronic candidial meningitis: An uncommon manifestation of candidiasis. Clin Infect Dis 1994;19:60-6.  Back to cited text no. 6  [PUBMED]  
7.Ralph ED, Hassan Z. Chronic meningitis caused by Candida albicans in a liver transplant recipient: Usefulness of polymerase chain reaction for diagnosis and monitoring of treatment. Clin Infect Dis 1996;23:191-2.  Back to cited text no. 7    
8.Casodo JL, Quereda C, Oliva J, Navas E, Moreno A, Pintado V, et al . Candidial meningitis in HIV infected patients: Analysis of 14 cases. Clin Infect Dis 1997;25:673-6.  Back to cited text no. 8    
9.Fernandez M, Moylett EH, Noyola DE, Baker CJ. Candidial meningitis in neonates - 10 year review. Clin Infect Dis 2000;31:458-63.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]




 

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    Introduction
    Case History
    Discussion
    References

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