Case report of central nervous system infection caused by Candida krusei

doi:10.3969/j.issn.1674-8115.2026.05.016

Abstract

Abstract:

Central nervous system (CNS) infections are common complications following neurosurgery, with bacteria being the predominant pathogens, while fungal infections are rare. This article reports the diagnosis and treatment of a patient with traumatic intracerebral hemorrhage who underwent craniotomy. One month after surgery, the patient developed unexplained fever, lethargy, and neck stiffness, raising a high clinical suspicion of CNS infection. However, conventional cerebrospinal fluid (CSF) routine and biochemical tests lacked specificity, and CSF culture was negative. Consequently, metagenomic next-generation sequencing (mNGS) of the CSF was performed. The mNGS results identified Pichia kudriavzevii (clinically known as Candida krusei). Based on the patient's clinical manifestations, signs, and auxiliary examination findings, a diagnosis of CNSinfection caused by Candida krusei was made. After more than 4 weeks of antifungal therapy with voriconazole, the patient′s condition improved and the patient was discharged. No recurrence was observed during follow-up. This case suggests that for CNS infections with atypical clinical presentations and nonspecific routine laboratory findings, mNGS can rapidly and accurately identify rare pathogens, providing a key basis for early targeted therapy and contributing to improved patient outcomes.

Key words: central nervous system infection, Candida krusei, Pichia kudriavzevii, metagenomic next-generation sequencing (mNGS)

CLC Number:

R446.5

Deng Yuanyuan, Yuan Yuan. Case report of central nervous system infection caused by Candida krusei[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(5): 688-692.

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References 26

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Item	2024-12-06	2024-12-12	2024-12-29	2025-01-15
Routine examination
Color	Pale yellow	Pale yellow	Colorless	Colorless
Clarity	Clear	Clear	Clear	Clear
Coagulability	No clots	No clots	No clots	No clots
Protein (Qualitative)	Positive	Negative	Negative	Negative
RBC count/(×10⁶/L)	1	52	80	0
WBC count/(×10⁶/L)	9	13	17	3
Biochemical examination
Total protein/(mg·dL^-1)	105(↑)	46(↑)	38	31
Chloride/(mmol·L^-1)	117(↓)	115(↓)	124	126
Glucose/(mmol·L^-1)	3.29	3.03	3.14	3.70
LDH/(U·L^-1)	58(↑)	33	24	18
ADA/(U·L^-1)	0.2	0.6	0.4	2.0
Pressure/mmH₂O	250(↑)	200(↑)	50	60

Item	2024-12-06	2024-12-12	2024-12-29	2025-01-15
Routine examination
Color	Pale yellow	Pale yellow	Colorless	Colorless
Clarity	Clear	Clear	Clear	Clear
Coagulability	No clots	No clots	No clots	No clots
Protein (Qualitative)	Positive	Negative	Negative	Negative
RBC count/(×10⁶/L)	1	52	80	0
WBC count/(×10⁶/L)	9	13	17	3
Biochemical examination
Total protein/(mg·dL^-1)	105(↑)	46(↑)	38	31
Chloride/(mmol·L^-1)	117(↓)	115(↓)	124	126
Glucose/(mmol·L^-1)	3.29	3.03	3.14	3.70
LDH/(U·L^-1)	58(↑)	33	24	18
ADA/(U·L^-1)	0.2	0.6	0.4	2.0
Pressure/mmH₂O	250(↑)	200(↑)	50	60