[Candida meningitis, in a premature infant, treated with liposomal amphotericin B and flucytosine].
BACKGROUND
Candida meningitis in infancy is becoming more common. Its treatment is difficult and may benefit from liposomal amphotericin B.


METHODS
A preterm infant developed necrotizing enterocolitis on day 4. Antibiotic therapy included cefotaxime, gentamicin, vancomycin and metronidazole; a central catheter was inserted for nutrition. An acute meningitis developed on day 17 and CT scan showed several brain abscesses. Candida albicans was recovered from the feces, urine and gastric fluid on day 19 and the infant was treated with fluconazole. This drug was replaced by amphotericin B and fluorocytosin when CSF studies a few days later showed persistent meningitis and the presence of Candida albicans. There was no sign of endocarditis. 3 days later, amphotericin B was replaced by liposomal amphotericin B at a dose of 3 mg/kg/day, while the initial catheter was removed. The CSF values and CT scan images gradually improved on this treatment. Liposomal amphotericin B and fluorocytosin treatment was interrupted on day 94, and replaced by oral fluconazole for 5 weeks. These drugs were very well tolerated and further studies at 6 months of age showed that the infant was normal, with no sign of immune deficiency.


CONCLUSIONS
This infant showed several indications of a bad prognosis. But treatment of Candida meningitis liposomal amphotericin B seemed to greatly improve the management of this severe infection.
Houmeau
L
L
Service de Pédiatrie B, Hôpital Saint-Vincent-de-Paul, Paris.
Monfort-Gouraud
M
M
Boccara
J F
JF
Badoual
J
J
D000666:Amphotericin B / Q000008:administration & dosage* / Q000627:therapeutic use; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy*; D004337:Drug Carriers; D005437:Flucytosine / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008081:Liposomes; D016921:Meningitis, Fungal / Q000175:diagnosis / Q000188:drug therapy*
D004337:Drug Carriers; D008081:Liposomes; D000666:Amphotericin B; D005437:Flucytosine
Méningite à Candida, chez un prématuré, traité par amphotéricine B liposomale et flucytosine.