Treatment of Indolent, Nonencapsulated Cryptococcal Meningitis Associated with Hydrocephalus

Garber, Sarah T.; Penar, Paul L.

doi:10.4081/cp.2012.e22

Cited by 7 publications

(5 citation statements)

References 10 publications

(15 reference statements)

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“…This patient without apparent immunodeficiency presented with cryptococcal meningitis complicating communicating hydrocephalus similar to other reports [ 1 , 2 , 4 , 6 , 8 ]. However, this patient was initially misdiagnosed with normal pressure hydrocephalus requiring VP shunt placement, although the CSF culture completed 2 yrs earlier had revealed the presence of C. gattii infection.…”

Section: Discussionsupporting

confidence: 89%

Undiagnosed Cryptococcus gattii meningitis leading to subsequent ventriculoperitoneal shunt infection in a patient with symptoms of normal pressure hydrocephalus: case report and literature review

2018

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BackgroundCryptococcus gattii is known to be an etiologic agent of human cryptococcosis, particularly in immunocompetent persons. C. gattii infection usually involves the central nervous system, the respiratory tract, or may be disseminated. Here we report an atypical manifestation of C. gattii infection in a patient who had C. gattii meningitis complicating the ventriculoperitoneal (VP) shunt infection and concurrent infected intraabdominal VP shunt pseudocyst.Case presentationA 66-year-old Thai female was initially diagnosed with normal pressure hydrocephalus (NPH) and underwent programmable VP shunt placement. However, she still suffered from recurrent communicating hydrocephalus with in-place VP shunt, and later developed recurrent gait impairment, chronic abdominal pain and abdominal mass. Radiological studies demonstrated recurrent hydrocephalus and a very large intraabdominal VP shunt pseudocyst. C. gattii was isolated from both the cerebrospinal fluid and the pseudocyst aspiration. C. gattii meningitis complicating the VP shunt infection and concurrent infected intraabdominal VP shunt pseudocyst was diagnosed. Prolonged antifungal therapy, removal of the infected VP shunt with subsequent implant of a new shunt provided a good outcome.ConclusionChronic C. gattii meningitis should be aware in a patient presenting with normal pressure hydrocephalus. Under-diagnosed cryptococcal meningitis following VP shunt insertion for treating the hydrocephalus can render a complicated VP shunt infection including infected VP shunt pseudocyst.

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Section: Discussionsupporting

confidence: 89%

Undiagnosed Cryptococcus gattii meningitis leading to subsequent ventriculoperitoneal shunt infection in a patient with symptoms of normal pressure hydrocephalus: case report and literature review

2018

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“…Garber and Penar describe a young immunocompetent woman presenting with occipital headache, hydrocephalus, elevated intracranial pressure (20–30 cm H 2 O), normal protein and glucose, lymphocytic pleocytosis (WBCs 15, RBCs 5, and 80% lymphs), and CSF culture revealing nonencapsulated C. neoformans with a negative antigen test [ 26 ]. While our patient did not have elevated intracranial pressure, he did exhibit lymphocytic pleocytosis and hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Challenges ofCryptococcus neoformansin an Immunocompetent Individual Masquerading as Chronic Hydrocephalus

Mahajan

Roberts

Curtis

et al. 2016

Case Reports in Neurological Medicine

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Cryptococcus neoformans can cause disseminated meningoencephalitis and evade immunosurveillance with expression of a major virulence factor, the polysaccharide capsule. Direct diagnostic assays often rely on the presence of the cryptococcal glucuronoxylomannan capsular antigen (CrAg) or visualization of the capsule. Strain specific phenotypic traits and environmental conditions influence differences in expression that can thereby compromise detection and timely diagnosis. Immunocompetent hosts may manifest clinical signs and symptoms indolently, often expanding the differential and delaying appropriate treatment and diagnosis. We describe a 63-year-old man who presented with a progressive four-year history of ambulatory dysfunction, headache, and communicating hydrocephalus. Serial lumbar punctures (LPs) revealed elevated protein (153–300 mg/dL), hypoglycorrhachia (19–47 mg/dL), lymphocytic pleocytosis (89–95% lymphocyte, WBC 67–303 mg/dL, and RBC 34–108 mg/dL), and normal opening pressure (13–16 cm H2O). Two different cerebrospinal fluid (CSF) CrAg assays were negative. A large volume CSF fungal culture grew unencapsulated C. neoformans. He was initiated on induction therapy with amphotericin B plus flucytosine and consolidation/maintenance therapy with flucytosine, but he died following discharge due to complications. Elevated levels of CSF Th1 cytokines and decreased IL6 may have affected the virulence and detection of the pathogen.

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“…Of the 46 studies included, 20 were cohorts 4 , 10 , 14 – 18 , 21 – 33 and 26 were case reports/series. 12 , 34 – 58 The cohort studies were divided in 7 two-arm (groups with and without shunt) and 13 one-arm (group with shunt) studies, and their characteristics are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review

Cornejo-Venegas,

Carreras,

Salcedo

et al. 2024

Therapeutic Advances in Infection

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Objective: This scoping review aimed to describe studies that evaluate the management of cryptococcal meningitis (CM) using cerebrospinal fluid (CSF) shunts, types of shunts used, and clinically relevant patient outcomes. Methods: We searched in the following databases: PubMed, Web of Science/Core collection, Embase, the Cochrane Library, and clinicaltrials.gov on 1 April 2022. We included two-arm and one-arm cohort studies that evaluated clinically relevant patient outcomes. Case reports were used to describe the type of CSF shunts used and the rationale behind its selection. The selection and extraction processes were independently performed by two authors. Results: This study included 20 cohort studies and 26 case reports. Only seven cohort studies compared two groups. Ventriculoperitoneal shunt was the most commonly used type of shunt (82.1%). The main indications for placing a shunt were persistently high opening pressure (57.1%) and persisting neurological symptoms or deterioration (54.3%). Cohort studies suggest that patients with shunt showed improvement in some outcomes such as neurological symptoms and hospital stay length. The most common shunt complications were post-operative fever (1–35.6%) and shunt obstruction (7–16%). Conclusion: CSF shunts may improve some clinically relevant outcomes in patients with CM, but the evidence is very uncertain.

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Treatment of Indolent, Nonencapsulated Cryptococcal Meningitis Associated with Hydrocephalus

Cited by 7 publications

References 10 publications

Undiagnosed Cryptococcus gattii meningitis leading to subsequent ventriculoperitoneal shunt infection in a patient with symptoms of normal pressure hydrocephalus: case report and literature review

Undiagnosed Cryptococcus gattii meningitis leading to subsequent ventriculoperitoneal shunt infection in a patient with symptoms of normal pressure hydrocephalus: case report and literature review

Diagnostic Challenges ofCryptococcus neoformansin an Immunocompetent Individual Masquerading as Chronic Hydrocephalus

Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review

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