Candida glabrata meningitis in a patient with newly diagnosed acquired immunodeficiency syndrome from Sikkim, India

Background and purpose: Candida infections in India have shifted, with an increase in the incidence rate of invasive candidiasis, particularly due to non-albicans species. The central nervous system infections by Candida glabrata are sparsely reported and more understanding and research is needed regarding these infections.

Case report: This study reported an unusual case of C. glabrata meningitis in a middle-aged female with pulmonary tuberculosis and newly diagnosed acquired immunodeficiency syndrome with a low cluster of differentiation 4 count (12 cells/mm³). Initially, the patient was treated with fluconazole. Subsequently, the patient underwent therapy involving amphotericin B and flucytosine. The cerebrospinal fluid cultures eventually grew C. glabrata, confirmed by matrix-assisted laser desorption ionization time-of-flight analysis. Despite switching to amphotericin B and flucytosine, the conditions of the patient deteriorated, leading to her death.

Conclusion: Candida glabrata candidemia requires meticulous and vigilant management due to its high mortality rate and relatively higher resistance to azoles, particularly fluconazole. This case underscored the severe and pressing challenges in the management of C. glabrata meningitis, particularly in immunocompromised patients.