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Meningitis caused by Candida spp. in a tertiary-care hospital: a 14-year review

Abstract number: 1733_764

Calabuig E., Pemán J., Salavert M., Amselem L., Bosch M., Viudes A., Gobernado M.

Introduction: Meningitis caused by Candida species is a serious condition that may result in significant morbidity and morbility if not recognized and treated effectively. Although meningitis due to Candida spp. remains rare, the frequency of this life-threatening infection has increased in the last years, particularly in patients undergoing neurosurgical procedures (6–17%).

Methods: We have reviewed retrospectively demographic, clinical and microbiological data of patients with isolation of Candida spp. from cerebrospinal fluid (CSF) at the La Fe University Hospital, a tertiary-care hospital in Valencia, Spain, during the period of 1993–2006.

Results: A total of 18 patients, (10 children and 8 adults, with ages ranging from 15 days to 78 years) had positive CSF cultures for Candida spp. accompanied by symptoms consistent with infection. Five patients were female. All cases of meningitis had a nosocomial origin. The species isolated (n = 20) were: C. albicans (n = 12), C. parapsilosis (n = 4), C. tropicalis (n = 3) and C. glabrata (n = 1). Two patients had two different episodes. All patients presented one or more underlying conditions predisposing to meningitis (9 hidrocephalus, 12 recent neurosurgical procedures and 12 CSF shunt). Shunt removal was performed in 10 episodes, but all the patients were treated with different antifungal regimens, including fluconazole, flucytosine, deoxicolate or liposomal amphotericin B. Ten patients (55.6%) survived the infection, six patients (33.3%) died from infection (attributable mortality), whereas two patients (11.1%) died from unrelated causes.

Conclusions:Candida meningitis represents a significant nosocomial infection in at-risk patients and is associated with high mortality rates. It is more common in children (55.5%) than in adults. C. albicans is the predominant causative agent (60%), although other Candida spp. are also associated with these infections. Adequate management of Candida meningitis includes instauration of adequate antifungal therapy and removal of contaminated shunts.

This study has been partially financed by a Grant (2/2005/0140) from the Fundación Investigación del HU La Fe and a Grant from the ISCIII (CM04/00248).

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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