Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China.
Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, China.
Medicine (Baltimore). 2021 Sep 17;100(37):e27205. doi: 10.1097/MD.0000000000027205.
Studies on Candida infections in the central nervous system, especially in infants and young children that did or did not have postoperative surgery, are rarely reported. Thus far, intrathecal (i.t.) amphotericin B (AmB) is not routinely recommended as a therapy for Candida meningitis. We report the first case of Candida meningitis in an infant who underwent abdominal surgery and was successfully treated with i.t. and intravenous (i.v.) AmB in the mainland of China.
Candida meningitis was confirmed by culture and immunoserological tests in a 1-day-old girl after surgery. She was treated with fluconazole for 1 month, but the patient's symptoms showed no improvement.
After surgery, the infant started having recurrent attacks of fever, and laboratory tests of the cerebrospinal fluid (CSF) revealed antigens of Candida tropicalis. CSF tests revealed a high total protein level and a low glucose level. She was diagnosed with a secondary Candida meningitis.
After azole therapy failure, intrathecal and intravenous AmB therapy were used as rescue therapies.
After nearly 2 months of AmB treatment, all repeat CSF cultures were negative, the infant was deemed stable and was discharged home, and she continued taking voriconazole orally as an outpatient.
The combination of i.t. and i.v. administration of AmB can provide a safe and effective alternative to managing this rare but severe disease.
中枢神经系统真菌感染的研究，尤其是术后婴儿和幼儿的研究，鲜有报道。迄今为止，鞘内（i.t.）两性霉素 B（AmB）尚未常规推荐用于治疗念珠菌性脑膜炎。我们报告了中国大陆首例腹部手术后发生念珠菌性脑膜炎的婴儿病例，该患儿经 i.t.和静脉（i.v.）两性霉素 B 治疗成功。
一名 1 天大的女婴在手术后经培养和免疫血清学检查确诊为念珠菌性脑膜炎。她接受氟康唑治疗 1 个月，但症状无改善。
手术后，婴儿开始反复发热，脑脊液（CSF）的实验室检测显示热带念珠菌抗原。CSF 检查显示总蛋白水平升高，葡萄糖水平降低。患儿被诊断为继发性念珠菌性脑膜炎。
唑类药物治疗失败后，采用鞘内和静脉两性霉素 B 治疗作为挽救性治疗。
近 2 个月的两性霉素 B 治疗后，所有重复 CSF 培养均为阴性，患儿病情稳定出院，继续门诊口服伏立康唑。
两性霉素 B 的 i.t.和 i.v.联合给药为治疗这种罕见但严重的疾病提供了一种安全有效的替代方案。
