Neonatal Candida parapsilosis meningitis and empyema related to epidural migration of a central venous catheter

• Published in: Clinical neurology and neurosurgery Vol. 110; no. 6; pp. 614 - 618
• Main Authors: Carter, J. Elliot, Laurini, Javier A, Evans, Tara N, Estrada, Benjamin
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.06.2008; Elsevier Science; Elsevier Limited
• Subjects: Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; Biological and medical sciences; Candida; Candida parapsilosis; Candidiasis - complications; Candidiasis - diagnostic imaging; Candidiasis - microbiology; Catheter; Catheterization, Central Venous - adverse effects; Catheters; Drug therapy; Empyema; Empyema - diagnostic imaging; Empyema - etiology; Empyema - microbiology; Epidural; Epidural Space - pathology; Epidural Space - surgery; Fluconazole - therapeutic use; Foreign-Body Migration - etiology; Foreign-Body Migration - pathology; Humans; Infant, Newborn; Infections; Male; Medical sciences; Meningitis; Meningitis, Fungal - diagnostic imaging; Meningitis, Fungal - etiology; Meningitis, Fungal - microbiology; Mortality; Neurology; Neurosurgery; Nosocomial infections; Radiography; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Venous; Catheter; Epidural; Meningitis; Empyema; Venous; Candida parapsilosis; Human; Nervous system diseases; Intravenous administration; Infection; Extradural; Newborn; Surgery; Central nervous system disease
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2008.03.012

Abstract C andida parapsilosis is an extremely rare cause of meningitis. We report the case of a neonate born at 26 + 4 weeks of gestation who was admitted to the neonatal intensive care unit at our institution due to respiratory immaturity. During the course of a 3-month hospitalization, the neonate developed fever and lethargy. A lumbar puncture revealed milky-white, turbid cerebrospinal fluid which contained many nucleated cells, mostly neutrophils. Microscopic examination of the cerebrospinal fluid revealed marked acute inflammation and fungal yeast forms, and cultures of the cerebrospinal fluid and peripheral blood yielded C. parapsilosis . Imaging studies subsequently revealed a subdural empyema related to epidural migration of a central venous catheter (CVL). The neonate received extended therapy with amphotericin B and fluconazole. He responded favorably to therapy and was discharged 3 months after birth. This case underscores the clinical importance of the recognition and treatment of a potentially lethal fungal pathogen of the central nervous system and the need for awareness of complications resulting from CVL malposition.