Candida albicans ventriculoperitoneal shunt infections: Immunocompetent preterm pediatric case series and an extensive review of literature

Cerebrospinal fluid shunt devices are increasingly being used for decompression, and despite excellent results, obstruction and infection are concerning complications, with underlying fungal etiology a rare consideration. In this study, we focus on pediatric shunt infections caused by Candida albicans in an extensive literature review and by reporting two additional cases. Very limited information regarding diagnosis and treatment of the Candidal shunt infections is available. Prematurity and use of broad spectrum antibiotics have been postulated as risk factors, and a CSF analysis prior to surgical placement of the shunt should be implemented as standard practice. Based on our cases, we suggest establishing the diagnosis based on a single positive fungal culture, and to initiate with intravenous and intraventricular antifungal therapy for two weeks, switching to oral antifungal medication for a total of 43 days in an outpatient setup without immediate ventriculoperitoneal shunt removal.