title: Voriconazole treatment of Candida tropicalis meningitis: persistence of (1,3)-β-D-glucan in the cerebrospinal fluid is a marker of clinical and microbiological failure: A case report.
abstract: BACKGROUND
  Infections are still the most common complications of cerebral shunt procedures. Even though fungal etiologies are considered to be rare, they are associated with significant morbidity and mortality. Due to their uncommonness, diagnostic procedures and optimal therapy are poorly defined. We report a case of Candida tropicalis infection of ventriculo-peritoneal cerebrospinal fluid (CSF) shunt in a 49-year-old immune competent male treated with voriconazole (VOR).
  
  
  METHODS
  Microbiological and CSF markers (1,3-b-D-glucan-BDG) of fungal infection, biofilm production capacity, sensitivity of serial isolates of the pathogen, and the concentration of the antifungal drug have been monitored and related to the clinical course of this infection.
  
  
  RESULTS
  Despite appropriate treatment with VOR, in terms of adequate achieved CSF drug concentrations and initial effective therapeutic response, loss of VOR susceptibility of the C tropicalis and treatment failure were observed.
  
  
  CONCLUSIONS
  Biofilm production of the C. tropicalis isolate might have had a significant role in treatment failure. Of interest, clinical and microbiological unfavorable outcome was anticipated by persistence of BDG in CSF. Rising titers of this marker were associated with relapse of fungal infection.
authors: Department of Public Health and Infectious Diseases. University of Rome "Sapienza", Azienda Policlinico Umberto I, Rome Department of Health Sciences (DSS), Section of Clinical Pharmacology and Oncology, Università degli Studi, Florence, Italy.
authors: Giancarlo
authors: G
authors: Ceccarelli
authors: Maria Cristina
authors: MC
authors: Ghezzi
authors: Giammarco
authors: G
authors: Raponi
authors: Grazia
authors: G
authors: Brunetti
authors: Carolina
authors: C
authors: Marsiglia
authors: Stefania
authors: S
authors: Fallani
authors: Andrea
authors: A
authors: Novelli
authors: Mario
authors: M
authors: Venditti
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D018441:Biofilms; D015415:Biomarkers / Q000134:cerebrospinal fluid; D041022:Candida tropicalis; D025141:Drug Resistance, Fungal; D017809:Fatal Outcome; D006801:Humans; D007121:Immunocompetence; D008297:Male; D016921:Meningitis, Fungal / Q000188:drug therapy*; D008875:Middle Aged; D011509:Proteoglycans; D065819:Voriconazole / Q000008:administration & dosage / Q000009:adverse effects*; D047071:beta-Glucans / Q000134:cerebrospinal fluid*
chemical_list: D000935:Antifungal Agents; D015415:Biomarkers; D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K; D065819:Voriconazole