Intracranial Candida Auris Infection: A Case Report and Scoping Review.

Abstract

Candida auris (C. auris) is a multidrug-resistant yeast capable of causing invasive infections in both immunocompromised and immunocompetent hosts. While bloodstream and wound infections are well described, central nervous system (CNS) involvement remains rare and poorly characterized. We present a case of C. auris CNS infection and a scoping review of adult cases to identify trends in diagnosis and treatment. We searched PubMed, Embase, Scopus, Web of Science, and Europe PMC for reports from 2009 to 2025 using CNS-specific and C. auris-specific terms. After deduplication and dual screening, 9 publications describing 11 cases met all criteria. Data on presentation, diagnostics, therapy, surgical intervention, and outcomes were extracted. Patients (aged 33-71 years) commonly presented with fever, headache, altered mental status, focal deficits, or hydrocephalus. Diagnosis relied on culture, molecular methods, or high clinical suspicion. Cerebrospinal fluid analyses typically demonstrated pleocytosis, elevated protein, and hypoglycorrhachia. Liposomal amphotericin B therapy was most frequently employed, often with flucytosine or echinocandins. Echinocandin monotherapy proved unreliable due to poor CNS penetration. Intrathecal echinocandins with systemic flucytosine achieved rapid clearance in selected cases. Voriconazole-micafungin combinations showed promise. Eight patients recovered with minimal sequelae; 4 had significant morbidity or mortality. Key themes include 1) neurosurgical devices markedly increase CNS C. auris risk, 2) rapid diagnostics and susceptibility-guided therapy are imperative, 3) regimens targeting both systemic and CNS compartments may improve outcomes, and 4) device management is critical. Standardized protocols, multicenter registries, and pharmacokinetic studies are needed to guide treatment of this emerging, life-threatening infection.