[Systemic Candida albicans infection with neuromeningeal complication in a premature infant].
BACKGROUND
Systemic maternal-fetal Candida albicans infections are uncommon diseases with a poor outcome. An associated cerebromeningeal infection increases morbidity. We present a case of neuromeningeal candidiasis following systemic neonatal infection in a premature infant. Management and therapeutic difficulties are outlined.


METHODS
The patient was a male infant born preterm at 30 weeks gestation. During his first week of life, he developed a systemic infection with an associated symptomatic hydrocephalus. Systemic candidaisis with neuromeningeal complication was diagnosed five weeks later. Despite treatment including cerebrospinal fluid (CSF) shunting and antimycotic medications (flucytosin and amphotericin B), the candidal infection did not resolve. Infectious and mechanical complications of the CSF drainage were treated by several surgical interventions during the following months. At 10 months of life, there was clinical and laboratory evidence of active persistent neuromeningeal candidaisis. Finally, candidal infection was eradicated with intravenous administration of fluconazole. After five year follow-up, the intellectual and psychological status of the patient was quite satisfactory, and no neurological deficits were found on clinical examination.


CONCLUSIONS
Management of neuromeningeal candidaisis in premature infants is a challenging task particularly because of delayed diagnosis. Candida infection should routinely be suspected in cases of systemic infection with neurological impairment in premature infants. Fluconazole may constitute an efficient therapeutic option.
Esposito
P
P
Service de Neurochirurgie, Hôpital de Hautepierre, Strasbourg. p.espo@wanadoo.fr
Zerr
N
N
Kehrli
P
P
Pain
L
L
Maitrot
D
D
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002176:Candida albicans / Q000302:isolation & purification*; D002177:Candidiasis / Q000134:cerebrospinal fluid / Q000150:complications* / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000209:etiology; D007231:Infant, Newborn; D007234:Infant, Premature; D008279:Magnetic Resonance Imaging; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D011859:Radiography
D000935:Antifungal Agents; D000666:Amphotericin B; D005437:Flucytosine