title: Candida parapsilosis meningitis associated with shunt infection in an adult male.
abstract: Candida parapsilosis is a very rare cause of meningitis. Though several cases have now been reported in neonates and children, only one has been described in an adult. We report on a 55-year-old male that was admitted due to altered mental status. He had recent sinus drainage and polypectomy, craniotomy with drainage of brain abscess, and ventriculo-peritoneal shunt placement. On admission, imaging studies showed no evidence of shunt dysfunction but did reveal extensive white matter decreased attenuation. Microscopic examination of the first 10 daily cerebrospinal fluid (CSF) cultures revealed yeast. Flucytosine and liposomal amphotericin B were started and externalization of shunt was performed on day 3. On day 8, CSF culture from admission grew C. parapsilosis; fluconazole was added. On day 10, daily CSF still showed yeast and cultures consistently grew C. parapsilosis. Shunt was removed and bilateral ventriculostomy drains were inserted. CSF after procedure as well as at follow-up examinations throughout his 3-month hospitalization were negative for yeast. Extended treatment with flucytosine and fluconazole was initiated. At 8-month follow-up, successful treatment of C. parapsilosis infection without recurrence was confirmed. This case underscores the need for suspicion of C. parapsilosis as a cause of meningitis after invasive surgeries in adults.
authors.affiliation: Jamaica Hospital Medical Center, Department of Internal Medicine, 8900 Van Wyck Expressway, Jamaica, NY 11418, United States. fbagheri@jhmc.org <fbagheri@jhmc.org>
authors.forename: Farshad
authors.initials: F
authors.lastname: Bagheri
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Cervellione
authors.forename: Mohammad
authors.initials: M
authors.lastname: Maruf
authors.forename: William
authors.initials: W
authors.lastname: Marino
authors.forename: Thomas
authors.initials: T
authors.lastname: Santucci
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000601:surgery*; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D002177:Candidiasis / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000382:microbiology; D004322:Drainage / Q000379:methods; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000382:microbiology*; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine