Candida cerebrospinal fluid shunt infection. Report of two new cases and review of the literature.

In this case report, we describe two patients with Candida shunt infection and review 22 cases from the previous literature. All of them had ventriculoperitoneal shunts, except one who had an external ventricular drain. The more outstanding predisposing factors were recent bacterial meningitis and/or neurosurgery (different from the shunt placement) and abdominal complications (intestinal perforation in three cases, and gastrostomy and lengthening of the distal catheter in one each). The clinical manifestations were hydrocephalus in 36%, fever in 31%, meningoencephalitis in 21%, and abdominal symptoms in 10%. The mean cerebrospinal fluid count was 78 cells/mm3 (with 77% lymphocytic predominance). Two patients died (9%); one of them was the only case in which the catheter was not removed. The recommended treatment is the replacement of the shunt and antifungal therapy with intravenous amphotericin B; in cases of poor clinical condition, the latter should also be given intraventricularly.