====== Candida ======


Candida is a genus of yeasts and is the most common cause of fungal infections worldwide.

Many species are harmless commensals or endosymbionts of hosts including humans; however, when mucosal barriers are disrupted or the immune system is compromised they can invade and cause disease.

see [[Candida albicans]].
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[[Candida]] spp. are responsible for the majority of fungal ventricular [[shunt infection]]s. Usually occurs in [[child]]ren < 1 year of age. 

Incidence: 1–7%
((Sanchez-Portocarrero J, Martin-Rabadan P, Saldana CJ,, et al. Candida cerebrospinal fluid shunt infection. Report of two new cases and review of the literature. Diagn Microbiol Infect Dis. 1994; 20:33–40)).
The 4th leading pathogen causing [[meningitis]] in neurosurgical patients in 1 study
((Nguyen MH, Yu VL. Meningitis caused by Candida species: an emerging problem in neurosurgical patients. Clin Infect Dis. 1995; 21:323–327)),
possibly related to the use of [[prophylactic antibiotics]] used for ICP monitoring and CSF drainage. Higher incidence in VP shunt patients with abdominal infections and shunts placed in patients with previous bacterial meningitis
((Geers TA, Gordon SM. Clinical significance of Candida species isolated from cerebrospinal fluid following neurosurgery. Clin Infect Dis. 1999; 28: 1139–1147)).
CSF typically shows elevated [[WBC]]s and [[protein]], normal [[glucose]]. 

Management recommendations:

1. completely remove the contaminated shunt (may be more important than with bacterial infections)

2. place a fresh [[external ventricular drain]] (if [[shunt-dependent hydrocephalus]])

3. treat with [[antifungal therapy]] (Liposomal [[amphotericin B]] 3–4 mg/kg IV daily + [[flucytosine]] 25 mg/kg PO QID).