Use of (1→3)-β-D-glucan Monitoring to Clear Candida metapsilosis Ventriculitis and Shunt Infection.

Background: Candida infections of the central nervous system (CNS) with intracranial shunts are difficult to treat. Cultures of cerebrospinal fluid (CSF) may lack sensitivity in detecting deep cerebral candidiasis.

Methods: The fungal biomarker (1→3)-β-D-glucan (BDG) in CSF and serum was used to assess therapeutic response in a child with device-associated recurrent infection from Candida metapsilosis . High-dose micafungin was used as the backbone of antifungal therapy.

Results: Antifungal therapy guided by resolution of elevated CSF and serum BDG provided the assurance of eradication of C. metapsilosis from CNS and peripheral tissues that permitted the insertion of a replacement ventriculoatrial shunt. Following placement of the ventriculoatrial shunt, there was no recurrence of CNS candidiasis.

Conclusion: Serial monitoring of BDG of CSF and serum allowed an individualized approach for intracranial shunt reimplantation. The child remained free of Candida CNS infection for 19 months before his death of unrelated causes.