Use of Cerebrospinal Fluid (1,3)-β-D-Glucan to Monitor Treatment Response in Candida albicans Meningitis in an HIV-infected Patient

Candida meningitis is rare in the setting of human immunodeficiency virus (HIV) infection and often presents a diagnostic challenge. Its clinical features typically mimic those of cryptococcal or tuberculous meningitis and Candida can be difficult to culture from cerebrospinal fluid. Furthermore, optimal treatment and monitoring parameters are not well defined. Cerebrospinal fluid levels of (1,3)-β-D-glucan, which is a component of the fungal cell wall, have been used to diagnose and monitor response to therapy in other cases of fungal meningitis, but its utility in the setting of Candida meningitis and HIV infection is less clear. Here, we present a case of spontaneous Candida albicans meningitis in a woman with advanced HIV infection and report on the clinical utility of cerebrospinal fluid (1,3)-β-D-glucan for diagnosis and monitoring of chronic infection. Correspondence to: Caitlin A. Moran, MD, Division of Infectious Diseases, Emory University School of Medicine, 49 Jesse Hill Jr Drive, Atlanta, GA 30303. E-mail: cmoran4@emory.edu. The authors have no conflicts of interest. Consent for publication: Informed consent for publication of this case report was provided by the patient. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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