Clinical Analysis of Intravenous and Oral Sequential Treatment With Voriconazole for Candida Central Nervous System Infection in Six Premature Infants

Zhu, Yingying; Gong, Xiaohui; Li, Zhiling; Wang, Danni; Yan, Chongbing

doi:10.3389/fphar.2021.631293

Cited by 4 publications

(1 citation statement)

References 26 publications

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“…1 Amphotericin B is the preferred for treatment of Candida meningitis, although fluconazole can be used in mild cases or when amphotericin B is not tolerated. 2 According to previous case reports, Candida meningitis can be well-managed using standardized treatment with fluconazole alone, 3 voriconazole, 4,5 and amphotericin B combined with flucytosine. 3,6 Clinical studies have also shown that amphotericin B colloidal dispersion (ABCD) has similar efficacy 7 and less nephrotoxicity 8 compared to liposomal amphotericin B with respect to antifungal activity.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Successful Treatment of Recurrent Candida Albicans Meningitis with Kimura’s Disease Using Amphotericin B Colloidal Dispersion Combined with Fluconazole

Shen,

Zhou,

Zhang

et al. 2023

IDR

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Background Candida albicans meningitis is a fungal infectious disease of the central nervous system that most often occurs in immunodeficient populations. Kimura’s disease is an IgE-mediated inflammatory reactive disease that is a chronic immune disorder with predominantly lymph node, soft tissue, and salivary gland damage, the treatment of which is hormone-based. The combination of Kimura’s disease with C. albicans meningitis is relatively uncommon. Herein, we report a case of C. albicans meningitis in combination with Kimura’s disease. Case Presentation The case is a 26-year-old male with a medical history of Kimura, who presented with symptoms of dizziness, headache, and double vision. Lumbar puncture and cerebrospinal fluid examination revealed an increased white blood cell count. Further analysis through cerebrospinal fluid culture and metagenomic second-generation sequencing (mNGS) led to the final diagnosis of C. albicans meningitis. The patient was treated with fluconazole after the onset of C. albicans meningitis and had a good response. During the treatment, changes in the pathogen genome sequences were monitored dynamically using metagenomic next-generation sequencing. After 1 year, the patient had a recurrence of Candida meningitis. Treatment with fluconazole alone was ineffective, while antifungal treatment with amphotericin B colloidal dispersion was effective with no detectable renal injury. Conclusion Candida meningitis can occur in the context of Kimura disease. In patients with mild disease, the possibility of recurrence exists with fluconazole treatment alone, and the efficacy of amphotericin B colloidal dispersion combined with fluconazole is better than fluconazole alone in patients with a recurrence. No nephrotoxicity was observed during amphotericin B colloidal dispersion treatment. The mNGS allows dynamic monitoring of pathogen sequencing reads, and for Candida meningitis, there may be a mismatch between peak sequencing reads and disease during treatment, the basis for which is unclear.

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