Prolonged Candidemia in Patients with Cancer

NOTE. AmB, amphotericin B; CVC, central venous catheter; Flu, fluconazole; Itr, itraconazole; Ket, ketoconazole. a Day that the first blood culture positive for Candida was performed. evaluation of CSF samples are inaccurate. Laboratory evaluation of the initial CSF sample revealed no eosinophils (not 3% eosinophils, as reported), and the diagnosis was made clinically, despite this finding. The second lumbar puncture showed 6% eosinophils (not 16% eosinophils, as reported) and was performed both in expectation of eosinophilia developing and in an attempt to help relieve the patient’s headache. Because a large number of people who arrive in Auckland are either migrants from the Pacific Islands or travelers returning from holidays spent in the Pacific Islands, where the disease is endemic, we are very familiar with eosinophilic meningitis due to A. cantonensis, and we see several cases per year. Indeed, 1 of the series of cases mentioned by Lo Re and Gluckman was evaluated and reported by our neurological colleagues at Auckland Hospital [2]. We do not, in general, find diagnosis of eosinophilic meningitis due to A. cantonensis to be “a major challenge,” because the condition has a characteristic clinical symptomatology with an appropriate epidemiological history (even without the presence of CSF or peripheral blood eosinophilia, as initially was the case for the woman described by Lo Re and Gluckman [1]) and is familiar to those of us in the fields of infectious diseases and neurology in this part of the world. Having said all that, we acknowledge that the ultimate proof of diagnosis was achieved by the Bangkok group mentioned in the article by Lo Re and Gluckman [1].