FLUCONAZOLE THERAPY IN A RHESUS-MONKEY (MACACA-MULATTA) WITH EPIDURALTRICHOSPORON BEIGELII IN A CEPHALIC RECORDING CYLINDER

An adult female rhesus monkey with a cephalic recording cylinder surgi cally implanted over a craniotomy site developed cloudy cylinder fluid and a white gelatinous plaque on the epidural capsule surface, Result s of baseline hematologic, serum biochemical, and cerebrospinal fluid analysis and simian retrovirus panel were unremarkable. Aerobic cultur e of the cylinder fluid yielded a pure culture of Trichosporon beigeli i. This organism is a ubiquitous saprophytic fungus that is a potentia l pathogen, especially in the immunocompromised host. Factors that cou ld have contributed to the infection included a microenvironment in th e cylinder that was favorable to fungal growth, and presence of a dura l psuedocapsule of collagen and granulation tissue in the implant whic h could have inhibited cellular defense mechanisms. An intravenous for mulation of fluconazole was selected for direct application into the r ecording. cylinder on the basis of safety and efficacy. Fluconazole is a highly water-soluble, metabolically stable bis-triazole antifungal with excellent cerebrospinal fluid penetration and low toxicity. A 4-w eek course of treatment eliminated Trichosporon organisms from the cyl inder. Change to oral administration of fluconazole was made at that t ime to allow use of cephalic cylinder antibiotics that are incompatibl e with fluconazole. Further treatment with fluconazole was continued o rally for 3 more months to prevent fungal recrudescence. Culture of cy linder fluid was performed periodically for 6 months after resolution, and results remained negative for T. beigelii. This case is believed to be the first reported T. beigelii infection in a non-human primate. Fluconazole was effective in eliminating the infection from the cylin der and preventing its recurrence.