Dawson Nancy L, Robles Hector A, Alvarez Salvador
Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.
Clin Neurol Neurosurg. 2005 Apr;107(3):243-5. doi: 10.1016/j.clineuro.2004.05.005.
Candida meningitis, a previously rare occurrence, has been increasing in prevalence and often is a result of complications of neurosurgery. We describe the case of a 49-year-old man who presented with headache, vertigo, intermittent blurred vision, and multiple episodes of nausea and vomiting. Computed tomography (CT) showed a left cerebellar hemorrhage with obliteration of the fourth ventricle causing hydrocephalus. He had an occipital craniotomy with transcondylar evacuation of the hemorrhage and placement of a temporary ventriculostomy. The hospital stay was prolonged because of postsurgical complications, and Candida tropicalis meningitis developed. Treatment was started with 400 mg of fluconazole administered intravenously every 12 h. In vitro susceptibility testing showed a minimum inhibitory concentration (MIC) to fluconazole of 1 microg/mL. Fluconazole was therefore continued orally for a total of 60 days, and the patient remained asymptomatic for 2 years. He then presented with increased vertigo and ataxia. Cerebrospinal fluid cultures grew C. tropicalis, which again showed susceptibility to fluconazole with a MIC of 1 microg/mL, identical to that in the previous infection. However, a second course of fluconazole failed to control the infection despite adequate cerebrospinal fluid levels.
念珠菌性脑膜炎以往较为罕见，但其发病率一直在上升，且常因神经外科手术并发症所致。我们描述了一例49岁男性患者的病例，该患者出现头痛、眩晕、间歇性视力模糊以及多次恶心和呕吐发作。计算机断层扫描（CT）显示左侧小脑出血，第四脑室闭塞导致脑积水。他接受了枕下开颅手术，经髁部清除血肿并放置了临时脑室造瘘管。由于术后并发症，住院时间延长，随后发生了热带念珠菌性脑膜炎。治疗开始时，每12小时静脉注射400毫克氟康唑。体外药敏试验显示对氟康唑的最低抑菌浓度（MIC）为1微克/毫升。因此，继续口服氟康唑共60天，患者2年无症状。之后他出现眩晕和共济失调加重。脑脊液培养出热带念珠菌，其对氟康唑的敏感性再次显示MIC为1微克/毫升，与之前感染时相同。然而，尽管脑脊液中药物浓度足够，但第二个疗程的氟康唑未能控制感染。
