Clinical Features of Neonatal Candida Meningitis and Usefulness of Ultrasound Examination

ABSTRACT

BACKGROUND: Candida species are becoming one of the most common pathogens associated with nosocomial infection in the neonatal intensive care units (NICU). This study was undertaken to investigate the clinical features and radiologic findings of meningitis complicating candida sepsis in the neonates. MATERIALS AND METHODS: Seventy-two neonates with Candida sepsis admitted to the NICU of Dongsan Medical Center, Keimyung University from Jan. 1997 to Dec. 2003 were enrolled. Medical records and serial radiologic images were reviewed retrospectively performed. RESULTS: Among a total of 72 patients with candida sepsis, meningitis developed in 12 cases (17%) and C. albicans was the only causative organism. Cerebrospinal fluid (CSF) analysis:showed pleocytosis in 9 cases (75%), protein elevation and candidal isolation in 7 cases (58%) each, and hypoglycorrhachia in 3 cases (25%). Of the 66 cases that underwent serial ultrasound examination, multiple cerebral microabscess was observed in 9 cases (14%); these lesions were also found on the brain MRI taken after the end of treatment in 7 cases (78%). In 2 cases (17%) without initial abnormal CSF findings, diagnosis was made through early ultrasound examination. In limited study of 49 neonates with C. albicans sepsis, demographic characteristics and risk factors between two groups (group 1with meningitis, group 2without meningitis) were similar, but fever or seizure at the onset of infection was more common in group 1 (P<0.05). The mortality rate was also higher in group 1, but it was not statistically significant. CONCLUSIONS: Candida meningitis is common in neonates with C. albicans sepsis and findings of CSF study were variable. Therefore, serial ultrasound examination may be of help in making correct diagnosis of central nervous system involvement.