Candida albicans ventriculoperitoneal shunt infections: Immunocompetent preterm pediatric case series and an extensive review of literature

Abstract

Cerebrospinal fluid shunt devices are increasingly being used for decompression, and despite excellent results, obstruction and infection are concerning complications, with underlying fungal etiology a rare consideration. In this study, we focus on pediatric shunt infections caused by Candida albicans in an extensive literature review and by reporting two additional cases. Very limited information regarding diagnosis and treatment of the Candidal shunt infections is available. Prematurity and use of broad spectrum antibiotics have been postulated as risk factors, and a CSF analysis prior to surgical placement of the shunt should be implemented as standard practice. Based on our cases, we suggest establishing the diagnosis based on a single positive fungal culture, and to initiate with intravenous and intraventricular antifungal therapy for two weeks, switching to oral antifungal medication for a total of 43 days in an outpatient setup without immediate ventriculoperitoneal shunt removal.

Alternative Antimicrobial Irrigation Strategies for the Treatment of Infections in Children: A Review of the Existing Literature

“…Similarly, Bhatti et al [ 22 ] reported on the cases of a 4-month-old female infant and a 5-month-old male infant with VP shunt-related meningitis due to azole-sensitive C. albicans . The two infants were treated with intrathecal L-amphotericin B irrigations combined with systemic therapy, without adverse events.…”

Candida albicans ventriculoperitoneal shunt infection in an infant: A case report and review of the literature

“…Limited evidence-based data are available for the optimal treatment of this rare infection. Both intravenous and intrathecal antifungal therapy have been described; however, there is a paucity of evidence to support the routine use of intrathecal/intraventricular antifungals (3,5). The Infectious Diseases Society of America (IDSA) recommends liposomal amphotericin B with or without oral flucytosine for the initial treatment of CNS candidiasis in patients outside the neonatal period (5).…”

“…The optimal duration of treatment following device removal is not known. Case reports describe success with 3 to 6 weeks of antifungal treatment (1,3,6,7). Sterility of the CSF should be documented.…”

“…The majority of Candida shunt infections occur in the younger pediatric population. A review by Bhatti et al identified 55 cases of Candida ventriculoperitoneal shunt infections reported over the span of 60 years(3). Almost half of those cases were in children under the age of 2 years.…”