Candidal Meningitis in Children with Cancer

Candidal meningitis is a rare disease that is seen most frequently in neonates, neurosurgical patients, and the immunocompromised host. We describe a series of 12 children with cancer (all of whom had leukemia) who had candidal meningitis develop. Univariate analysis revealed that duration of fever, antibiotic therapy, and profound neutropenia and use of total parenteral nutrition were signi®cantly associated ( ) with candidal meningitis in children with can-P!.05 cer, compared with matched control subjects. Only duration of profound neutropenia (P p) and use of total parenteral nutrition ( ) approached signi®cance in the multivariate.08 P p.06 analysis. One species of Candida, Candida tropicalis, was responsible for 11 of the 12 cases, indicating increased pathogenicity of this organism in CNS disease. The cases were invariably fatal, supporting aggressive treatment of candidal meningitis in immunocompromised patients and further study of the prevention, diagnosis, and management of C. tropicalis meningitis. Candidal meningitis is a rare disease that was ®rst reported in 1933 [1]. It is seen most commonly in critically ill neonates [2, 3], neurosurgical patients [4], and patients with risk factors for invasive fungal disease and disseminated candidiasis [5]. Very few cases of candidal meningitis have been described i