Clinical characteristics of central nervous system candidiasis due to Candida albicans in children: a single-center experience

• DOI: 10.1186/s12879-022-07924-z
• Publication Date: 2022-12-16T10:04:04Z
• Authors: Haijuan Xiao; Yiqing Miao; Linlin Liu; Wenya Feng; Shuping Liu; Lingyun Guo; Xin Guo; Tianming Chen; Bing Hu; Huili Hu; Fang Xu; Lianlian Han; Lili Ren; Wei Li; Gang Liu
• Keywords: Male; Central Nervous System; 0301 basic medicine; Antifungal Agents; Invasive candidiasis (IC); Research; Candidiasis; Infant; Whole-exome sequencing (WES); Infectious and parasitic diseases; RC109-216; Microbial Sensitivity Tests; Central nervous system candidiasis due to Candida albicans (CNSC); 3. Good health; 03 medical and health sciences; Central Nervous System Fungal Infections; Drug Resistance, Fungal; Candida albicans; Drug susceptibility test; Humans; Female; Child; Fluconazole

Abstract Background Central nervous system candidiasis due to Candida albicans (CNSC) in children is easily misdiagnosed and is associated with poor outcomes and a high mortality rate. There is no big data research or systematic review of CNSC.

Methods Patients diagnosed as CNSC with positive culture results of Candida albicans in Beijing Children’s Hospital affiliated to Capital Medical University from March 2010 to March 2019 were included. Patients receiving immunosuppressive therapy or transplantation, or with malignant tumours were excluded. We analysed the clinical characteristics, follow-up results, drug susceptibility tests and whole-exome sequencing (WES) results.

Results Thirty-three definitive patients were enrolled, including 22 males and 11 females. Twenty-five patients suffered from CNSC when they were less than 1 year old, and a total of 29 patients had high-risk factors. The main clinical manifestations were fever, convulsions, and positive neurological signs. Twenty-two patients had CNS infections alone, and 11 patients had CNS infections combined with invasive infections involving multiple sites. Twenty-seven cases had a positive CSF and/or blood culture at our hospital. All strains were susceptible to fluconazole, and 2 strains had intermediate susceptibility to voriconazole. As for amphotericin B, all the strains were wild type (WT). WES of 16 patients revealed 2 cases with CARD9 mutations, who suffered from recurrent onychomycosis or thrush before.

Conclusion CNSC mostly existed in children younger than 1 year old, who all had underlying risk factors. CNSC patients with onset at an older age or with recurrent superficial fungal infections might have primary immunodeficiency.