Candida Meningitis After Transsphenoidal Surgery: A Single-Institution Case Series and Literature Review

Kelly J. Bridges, Ryan Li, Maria Fleseriu, Justin Cetas

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Candida meningitis after neurosurgical procedures is a rare but potentially devastating complication. The presentation of meningitis can be insidious in immunosuppressed patients and thus can be easily overlooked. Cerebrospinal fluid studies often resemble bacterial profiles, and cultures can be falsely negative. Candida albicans is the most common species identified in postsurgical Candida meningitis, and delay in diagnosis and treatment can be devastating. The standard induction therapy for Candida meningitis has been amphotericin B combined with flucytosine. A high index of suspicion is needed in any patient with risk factors such as abdominal surgery, bowel perforation, recent broad spectrum antibiotic therapy, intravenous drug use, extremes of age, indwelling catheters, and immunosuppression such as AIDS, malignancy, antineoplastic therapy, and steroid use. Here, we describe 3 case presentations of patients with giant skull base tumors who developed postsurgical Candida meningitis, each with vastly different clinical courses and outcomes, ranging from benign to catastrophic. We performed a literature review with special focus on common risk factors, Candida species, diagnostic criteria, and treatment.

Original languageEnglish (US)
Pages (from-to)41-49
Number of pages9
JournalWorld Neurosurgery
Volume108
DOIs
StatePublished - Dec 1 2017

Keywords

  • Candida
  • Meningioma
  • Meningitis
  • Pituitary adenoma
  • Skull base surgery
  • Transnasal
  • Transsphenoidal
  • Vasospasm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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