CLINICAL-SIGNIFICANCE OF FUNGI ISOLATED FROM CEREBROSPINAL-FLUID IN CHILDREN

We reviewed the isolation of fungi from cerebrospinal fluid (CSF) cult ures at Texas Children's Hospital during the past 6 years to evaluate the significance of a positive culture and to identify potential risk factors. Thirty-seven fungal isolates were recovered from 23 patients representing 2% of all 1498 positive CSF cultures for the study period . Candida species accounted for 94.5% of all fungal isolates. Nine of the 23 patients were newborns and 8 of these were very low birth weigh t premature neonates. C. albicans was recovered from the CSF of all ne wborns. Eleven patients were children 4 months to 14 years old. Three patients had positive cultures of CSF obtained on postmortem examinati on. Leading potential risk factors for positive CSF cultures from neon ates included antimicrobial therapy, prematurity, very low birth weigh t, umbilical catheterization, total parenteral nutrition, intubation a nd respiratory distress syndrome. For children beyond the newborn peri od, potential risk factors were antimicrobial therapy for concurrent b acterial infection, chronic systemic or central nervous system disease and central venous catheterization. Disseminated fungal infection was documented in 40% of all patients with positive CSF cultures. Fungi r ecovered from 7 (35%) of 20 live patients were considered contaminants . We conclude that true fungal meningitis in children is accompanied b y multiple positive cultures from CSF or CSF and a second site. A sing le positive CSF culture far fungi should be considered significant whe n both CSF findings compatible with meningitis and associated risk fac tors are present. The isolation of fungi from a single CSF culture can be considered insignificant when CSF findings are within normal limit s despite the presence of potential risk factors or vice versa. The re covery of unlikely fungal pathogens from CSF should be evaluated on an individual basis.