Fadel Hassan, Moon Seong-Jin, Klinger Neil V, Chamiraju Parthasarathi, Eltahawy Hazem A, Moisi Marc D, Guthikonda Murali
Wayne State University School of Medicine, Department of Neurosurgery, Detroit, Michigan, USA.
Wayne State University School of Medicine, Department of Neurosurgery, Detroit, Michigan, USA.
World Neurosurg. 2018 Nov;119:290-293. doi: 10.1016/j.wneu.2018.08.023. Epub 2018 Aug 13.
Candida parapsilosis is an incredibly rare cause of ventriculoperitoneal (VP) shunt infections, with only 1 adult case reported in the literature to date.
We describe the case of a 45-year-old man admitted for a traumatic fall and subsequently treated with VP shunt placement for obstructive hydrocephalus secondary to a cerebellar contusion and intraventricular hemorrhage. Eight months following VP shunt placement, the patient presented with a 2-month history of clear fluid leakage through a dehiscent surgical abdominal wound overlying the distal VP shunt. Cerebrospinal fluid cultures were obtained and grew C. parapsilosis. The patient subsequently underwent VP shunt externalization and began antifungal treatment with intravenous liposomal amphotericin B. Cerebrospinal fluid studies continued to redemonstrate C. parapsilosis infection, for which VP shunt removal and external ventricular drain placement was performed. Three days into treatment with amphotericin B, he endured significant nephrotoxicity necessitating a switch to oral fluconazole. Following 3 weeks of oral fluconazole treatment with negative serial cerebrospinal fluid cultures, the patient underwent external ventricular drain removal and VP shunt insertion. Following the procedure and 22 total days of oral fluconazole treatment, our patient recovered well and was discharged to a rehabilitation facility in stable condition.
In our report, we describe the clinical course of our patient and offer a review and analysis of the most up-to-date literature concerning C. parapsilosis shunt infections, as well as treatment guidelines for central nervous system candidiasis.
近平滑念珠菌是脑室腹腔（VP）分流感染极其罕见的病因，迄今为止文献中仅报道过1例成人病例。
我们描述了一名45岁男性的病例，该患者因外伤跌倒入院，随后因小脑挫伤和脑室内出血继发梗阻性脑积水接受VP分流置入治疗。VP分流置入8个月后，患者出现有2个月病史的清亮液体自覆盖远端VP分流的腹部手术切口裂开处渗漏。获取脑脊液培养物，培养出近平滑念珠菌。患者随后接受VP分流外置，并开始用静脉脂质体两性霉素B进行抗真菌治疗。脑脊液检查持续再次显示近平滑念珠菌感染，为此进行了VP分流移除和外置脑室引流管置入。两性霉素B治疗3天后，他出现严重肾毒性，需要改用口服氟康唑。在口服氟康唑治疗3周且系列脑脊液培养结果为阴性后，患者接受了外置脑室引流管移除和VP分流置入。手术后及总共22天的口服氟康唑治疗后，我们的患者恢复良好，以稳定状态出院至康复机构。
在我们的报告中，我们描述了患者的临床病程，并对有关近平滑念珠菌分流感染的最新文献以及中枢神经系统念珠菌病的治疗指南进行了综述和分析。
