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.
Candida spp. are responsible for the majority of fungal ventricular shunt infections. Usually occurs in children < 1 year of age.
Incidence: 1–7% 1). The 4th leading pathogen causing meningitis in neurosurgical patients in 1 study 2), 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 3). CSF typically shows elevated WBCs 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).