Babici Denis, Mohamed Ali A, Mattner Olivia, Canosa Jessica, Gan Willy, Patel Pooja
Department of Neurology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA.
Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
eNeurologicalSci. 2024 Jul 28;36:100519. doi: 10.1016/j.ensci.2024.100519. eCollection 2024 Sep.
We present the fifth case of candida dubliniensis meningitis in a young immunocompetent host and suggest extracorporeal membrane oxygenation (ECMO) as a potential risk factor for colonization.
A 22-year-old immunocompetent female presented with a diagnosis of bacterial meningitis. Two years prior, she received ECMO for Covid-19 pneumonia complicated by viral myocarditis & Takutsobo cardiomyopathy. Following discharge, she reported headaches of increasing intensity, all refractory to treatments. Brain magnetic resonance imaging (MRI) was inconclusive. Two weeks prior to her presentation, she was admitted for worsening headaches with cranial nerve VI palsy. Lumbar puncture (LP) revealed white blood cell count (WBC) of 166 cells/μL with neutrophilic predominance and her symptoms progressed, despite 5 days of treatment with broad spectrum antibiotics. All cultures returned negative.
At her current presentation, repeat LP revealed 835 WBC/mm3, 225 mg/dL protein, and 4 mg/100 mL glucose. Brain MRI revealed nodular enhancement in the brainstem and communicating hydrocephalus. MRI of the lumbar spine revealed meningeal enhancement. Cerebrospinal fluid (CSF) cultures came back positive for C.dubliniensis. Treatment began with Amphotericin B and Flucytosine.
When clinical suspicion for fungal meningitis is high, repeate LP and CSF analysis is indicated to establish a definitive diagnosis and begin treatment. Additional studies are needed to confirm risk factors, like ECMO, for the colonization of C.dubliniensis, which likely predisposes individuals to invasive candidiasis.
我们报告了一例年轻免疫功能正常宿主发生的都柏林念珠菌脑膜炎病例，并提出体外膜肺氧合（ECMO）可能是其定植的危险因素。
一名22岁免疫功能正常的女性被诊断为细菌性脑膜炎。两年前，她因新冠病毒肺炎合并病毒性心肌炎及应激性心肌病接受了ECMO治疗。出院后，她报告头痛症状逐渐加重，所有治疗均无效。脑部磁共振成像（MRI）检查结果不明确。在就诊前两周，她因头痛加重伴第六对颅神经麻痹入院。腰椎穿刺（LP）显示白细胞计数（WBC）为166个/μL，以中性粒细胞为主，尽管使用广谱抗生素治疗了5天，她的症状仍有进展。所有培养结果均为阴性。
在此次就诊时，重复腰椎穿刺显示白细胞计数为835个/mm³，蛋白为225mg/dL，葡萄糖为4mg/100mL。脑部MRI显示脑干结节状强化及交通性脑积水。腰椎MRI显示脑膜强化。脑脊液（CSF）培养结果显示都柏林念珠菌阳性。治疗开始使用两性霉素B和氟胞嘧啶。
当临床高度怀疑真菌性脑膜炎时，需要重复腰椎穿刺和脑脊液分析以明确诊断并开始治疗。需要进一步研究以证实ECMO等危险因素与都柏林念珠菌定植的关系，都柏林念珠菌定植可能使个体易患侵袭性念珠菌病。
