Cryptococcal Meningitis

Berlin, Lisa; Pincus, Jonathan H.

doi:10.1001/archneur.1989.00520480054020

Cited by 33 publications

(4 citation statements)

References 31 publications

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“…It should be noted that diagnosis is difficult in immunocompetent hosts as the culture and antigen tests can be frequently negative. [ 15 ] The CSF white cells are elevated with a predominance of lymphocytes in HIV-negative individuals. CSF protein is usually elevated and glucose is low.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal meningitis masquerading as normal pressure hydrocephalus in an immune-competent adult

Raheja

Sinha

Irukulla

et al. 2017

J Global Infect Dis

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We report a case of acute cryptococcal meningitis (CM) masquerading as normal pressure hydrocephalus (NPH) in an immune-competent female. An 85-year-old human immunodeficiency virus-negative female presented to the emergency room for altered mental status and difficulty walking. She was increasingly lethargic, with urinary incontinence and gait instability. A previous computed tomography was reported to have ventricular dilatation out of proportion to the degree of cortical atrophy. Magnetic resonance scan of the brain revealed ventricular dilatation and subtle debris layering the occipital horns of the lateral ventricles. A working diagnosis of NPH had been made considering the clinical symptoms and imaging. She became febrile to 103°F. Lumbar puncture was then performed which showed increased protein, decreased glucose, and mononuclear pleocytosis. India ink preparation of the cerebrospinal fluid was positive for Cryptococcus along with a positive cryptococcal antigen test. The patient was started on treatment for CM, but the patient continued to deteriorate further and died on the same day. Blood cultures subsequently grew Cryptococcus neoformans as well.

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Section: Discussionmentioning

confidence: 99%

Cryptococcal meningitis masquerading as normal pressure hydrocephalus in an immune-competent adult

Raheja

Sinha

Irukulla

et al. 2017

J Global Infect Dis

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“…Although cryptococcal antigen agglutination test of CSF samples has a sensitivity of 100% and a specificity of 95% to 100%, there were case reports of false-negative cryptococcal antigen test results with culture-proven cryptococcal meningitis [ 6 , 15 , 16 ]. It was thought that this could be a result of low cryptococcal antigen concentrations in the CSF and also is dependent on the type of test kit used [ 6 , 11 , 12 ]. Other reported causes of negative cryptococcal antigen test results include prozone phenomenon [ 17 ] and isolation of small colony variant of Cryptococcus neoformans [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…The presented case is unique because the CSF culture from the shunt was initially negative but a second sample grew Cryptococcus neoformans. According to some studies, there had been reports that revealed failures to isolate causative agents in the cultures [ 11 , 19 ]. Nevertheless, the CSF culture from the shunt remains a mainstay for identifying cryptococcal shunt infection [ 7 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cryptococcus neoformans as a pathogen of VPS infections is rare and the diagnosis using CSF from the shunt can be particularly difficult [ 8 – 10 ]. In immunocompetent patients, cryptococcal antigen tests may be negative, which makes the diagnosis more challenging [ 11 , 12 ]. We present the case of an immunocompetent patient who was diagnosed with culture-proven Cryptococcus neoformans VPS infection.…”

Section: Introductionmentioning

confidence: 99%

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Cryptococcal Infection of the Ventriculoperitoneal Shunt in an Immunocompetent Patient

2016

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Patient: Male, 52Final Diagnosis: Cryptococcal ventriculoperitoneal shunt infectionSymptoms: Confusion • fever • LethargyMedication: Amphotericin B • FlucytosineClinical Procedure: Ventriculoperitoneal shunt removalSpecialty: Infectious diseaseObjective:Rare diseaseBackground:Ventriculoperitoneal shunting is an effective treatment for hydrocephalus. Ventriculoperitoneal shunt (VPS) infection is a common complication. Cryptococcus neoformans as an implicated organism is rare. In this report, we describe a patient with cryptococcal VPS infection.Case Report:A 52-year-old male with normal pressure hydrocephalus, status post implantation of VPS one year prior to the presentation; who was admitted with a fever, lethargy and confusion for three days. He was treated empirically with intravenous cefepime and vancomycin for VPS infection. The CSF analysis from both the lumbar puncture and the VPS was significant for a low white blood count, low glucose and high protein. Other work-up including India ink and cryptococcal antigen was unrevealing. He remained febrile despite antibiotic treatment for 5 days. The CSF from the shunt was sent for analysis again and it demonstrated similar results from the prior study, but the culture was now positive for Cryptococcus neoformans. The patient was started on oral flucytosine and intravenous liposomal amphotericin B. The VPS was removed and an externalized ventricular catheter was placed. The patient showed rapid resolution of the symptoms.Conclusions:To date, there was a total of nine reported cases of cryptococcal VPS infection upon review of the literature. Our presenting case and the literature review highlight the difficulties in making an accurate diagnosis of cryptococcal shunt infection. There were case reports of false negative cryptococcal antigen tests with culture proven cryptococcal meningitis. The CSF culture from the shunt remains a mainstay for identifying cryptococcal shunt infection. Cryptococcal shunt infections are rare and early diagnosis and treatment is essential for patient management which involves shunt replacement with concomitant administration of intravenous antifungal medication. High clinical suspicion is crucial and shunt culture preferably from the valve is recommended.

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Diagnostic Immunology

Desai¹,

Wong²

Infectious Disease

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Cryptococcal Meningitis

Cited by 33 publications

References 31 publications

Cryptococcal meningitis masquerading as normal pressure hydrocephalus in an immune-competent adult

Cryptococcal meningitis masquerading as normal pressure hydrocephalus in an immune-competent adult

Cryptococcal Infection of the Ventriculoperitoneal Shunt in an Immunocompetent Patient

Diagnostic Immunology

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