Management of pedıatrıc Candıda central nervous system ınfectıons: a retrospectıve analysıs of a challengıng case serıes.

PURPOSE: Central nervous system (CNS) infections caused by Candida species are serious clinical conditions associated with high morbidity and mortality, especially in children with neurosurgical devices. The aim of this study is to evaluate the clinical characteristics, changing microbiological profile, and treatment outcomes of pediatric Candida meningitis/ventriculitis cases followed in our center.

METHODS

Twenty-five pediatric patients followed at a tertiary referral center, with Candida growth in CSF or shunt culture between August 2018 and September 2025 were analyzed retrospectively. Demographic data, associated clinical characteristics, CSF findings, isolated species, and treatment approaches were analyzed.

RESULTS

The median age of the patients was 16.7 months (range 3.7-144), and 84% (n = 21) had a history of ventriculoperitoneal (VP) shunt. Prior broad-spectrum antibiotic use and history of neurosurgical intervention were detected in all patients (100%). CSF analysis revealed markedly elevated protein levels (median 294 mg/dL). Although Candida spp. (76%) was the leading isolate, Candida auris, considered a global threat, was detected in one case. Concomitant bacterial infection was observed in 68% of the cases. The median length of hospital stay was 60 days, and the mortality rate was 12%. Treatment failure was observed in cases where the shunt was not removed, whereas cure was achieved in patients who underwent shunt revision and systemic antifungal therapy.

CONCLUSION

The presence of a VP shunt and intensive antibiotic use are the primary predisposing factors for pediatric fungal CNS infections. The emergence of resistant species such as C. auris in childhood complicates treatment strategies. Immediate removal of the shunt and aggressive antifungal therapy targeted at the agent are essential for successful management.