title: Neonatal Candida parapsilosis meningitis and empyema related to epidural migration of a central venous catheter.
abstract: Candida parapsilosis is an extremely rare cause of meningitis. We report the case of a neonate born at 26+4 weeks of gestation who was admitted to the neonatal intensive care unit at our institution due to respiratory immaturity. During the course of a 3-month hospitalization, the neonate developed fever and lethargy. A lumbar puncture revealed milky-white, turbid cerebrospinal fluid which contained many nucleated cells, mostly neutrophils. Microscopic examination of the cerebrospinal fluid revealed marked acute inflammation and fungal yeast forms, and cultures of the cerebrospinal fluid and peripheral blood yielded C. parapsilosis. Imaging studies subsequently revealed a subdural empyema related to epidural migration of a central venous catheter (CVL). The neonate received extended therapy with amphotericin B and fluconazole. He responded favorably to therapy and was discharged 3 months after birth. This case underscores the clinical importance of the recognition and treatment of a potentially lethal fungal pathogen of the central nervous system and the need for awareness of complications resulting from CVL malposition.
authors.affiliation: University of South Alabama, Department of Pathology, 2451 Fillingim Street, Mobile, AL 36617, USA. ecarter@usouthal.edu
authors.forename: J Elliot
authors.initials: JE
authors.lastname: Carter
authors.forename: Javier A
authors.initials: JA
authors.lastname: Laurini
authors.forename: Tara N
authors.initials: TN
authors.lastname: Evans
authors.forename: Benjamin
authors.initials: B
authors.lastname: Estrada
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida; D002177:Candidiasis / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D004653:Empyema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000382:microbiology; D004824:Epidural Space / Q000473:pathology / Q000601:surgery*; D015725:Fluconazole / Q000627:therapeutic use; D005548:Foreign-Body Migration / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D016921:Meningitis, Fungal / Q000000981:diagnostic imaging / Q000209:etiology* / Q000382:microbiology; D011859:Radiography
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole