Use of Cerebrospinal Fluid Shunts in Patients Having Acquired Immunodeficiency Syndrome with Cryptococcal Meningitis and Uncontrollable Intracranial Hypertension

Bach, Michael C.; Tally, Philip W.; Godofsky, Eliot

doi:10.1097/00006123-199712000-00008

Cited by 58 publications

(77 citation statements)

References 7 publications

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“…Uncontrollable ICH due to cryptococcal meningitis in patients with AIDS plays an important role in morbidity and mortality 14 . In a recent study, Souza et al…”

mentioning

confidence: 99%

Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly

Corti

Priarone

Negroni

et al. 2014

Rev. Soc. Bras. Med. Trop.

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Introduction:Cryptococcosis is an opportunistic mycosis, especially in patients that are human immunodefi ciency virus (HIV)-positive, and frequently involves the central nervous system. Methods: We assessed the potential of ventriculoperitoneal shunting (VPS) in preventing mortality due to uncontrollable intracranial hypertension (ICH) in 15 patients with acquired immunodefi ciency syndrome (AIDS)-related cryptococcal meningitis. Results: After 2 weeks of antifungal therapy consisting of amphotericin B deoxycholate with or without fl uconazole, patients with persistent ICH underwent VPS, despite having persistent Cryptococcus neoformans infection. In 12 patients, the uncontrollable ICH was resolved by VPS. Conclusions: Patients with cryptococcal meningoencephalitis who have ICH must be considered for VPS even with positive cerebrospinal fl uid cultures.

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“…Uncontrollable ICH due to cryptococcal meningitis in patients with AIDS plays an important role in morbidity and mortality 14 . In a recent study, Souza et al…”

mentioning

confidence: 99%

Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly

Corti

Priarone

Negroni

et al. 2014

Rev. Soc. Bras. Med. Trop.

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“…In addition, several reports of C. neoformans infection of polytetrafluoroethylene peritoneal dialysis fistula and prosthetic cardiac valves highlight the ability of this organism to adhere to medical devices (6,7,26). In fact, the increasing use of ventriculoperitoneal shunts to manage intracranial hypertension associated with cryptococcal meningoencephalitis highlights the importance of investigating the biofilm-forming properties of this organism (2,13).…”

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confidence: 99%

Susceptibility of Cryptococcus neoformans Biofilms to Antifungal Agents In Vitro

Martinez

Casadevall

2006

Antimicrob Agents Chemother

177

176

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Microbial biofilms contribute to virulence and resistance to antibiotics by shielding microbial cells from host defenses and antimicrobial drugs, respectively. Cryptococcus neoformans was demonstrated to form biofilms in polystyrene microtiter plates. The numbers of CFU of disaggregated biofilms, 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyl]-2H-tetrazolium hydroxide reduction, and light and confocal microscopy were used to measure the fungal mass, the metabolic activity, and the appearance of C. neoformans biofilms, respectively. Biofilm development by C. neoformans followed a standard sequence of events: fungal surface attachment, microcolony formation, and matrix production. The susceptibilities of C. neoformans cells of the biofilm and planktonic phenotypes to four antifungal agents were examined. The exposure of C. neoformans cells or preformed cryptococcal biofilms to fluconazole or voriconazole did not result in yeast growth inhibition and did not affect the metabolic activities of the biofilms, respectively. In contrast, both C. neoformans cells and preformed biofilms were susceptible to amphotericin B and caspofungin. However, C. neoformans biofilms were significantly more resistant to amphotericin B and caspofungin than planktonic cells, and their susceptibilities to these drugs were further reduced if cryptococcal cells contained melanin. A spot enzyme-linked immunosorbent assay and light and confocal microscopy were used to investigate how antifungal drugs affected C. neoformans biofilm formation. The mechanism by which amphotericin B and caspofungin interfered with C. neoformans biofilm formation involved capsular polysaccharide release and adherence. Our results suggest that biofilm formation may diminish the efficacies of some antifungal drugs during cryptococcal infection.

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“…For instance, Walsh et al reported that C. neoformans could form biofilms in ventriculoatrial shunt catheters (27). The increasing use of ventriculoperitoneal shunts to manage intracranial hypertension associated with cryptococcal meningoencephalitis highlights the importance of investigating the biofilm-forming properties of this organism (2). Moreover, biofilm formation has profound consequences in the establishment of fungal infection and is associated with persistent infection since biofilms increase resistance to host immune mechanisms and antimicrobial therapy (7).…”

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confidence: 99%

Cryptococcus neoformans Cells in Biofilms Are Less Susceptible than Planktonic Cells to Antimicrobial Molecules Produced by the Innate Immune System

Martinez

Casadevall

2006

Infect Immun

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The human pathogenic fungus Cryptococcus neoformans can form biofilms on polystyrene plates and medical devices in a process that requires capsular polysaccharide release. Although biofilms are known to be less susceptible to antimicrobial drugs, little is known about their susceptibility to antimicrobial molecules produced by the innate immune system. In this study, we investigated the susceptibility of C. neoformans cells in biofilm and planktonic states to oxidative and nonoxidative antimicrobial molecules produced by phagocytic cells. The effects of various immune effector molecules on the fungal mass, metabolic activity, and architecture of C. neoformans biofilms were measured by colony counts, 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide reduction, and confocal microscopy, respectively. Biofilms were more resistant than planktonic cells to oxidative stress but remained vulnerable to cationic antimicrobial peptides. However, melanized biofilms were significantly less susceptible to antimicrobial peptides than nonmelanized biofilms. These results suggest that the biofilm phenotype increases resistance against host immune mechanisms, a phenomenon that could contribute to the ability of biofilm-forming microbes to establish persistent infections.

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Use of Cerebrospinal Fluid Shunts in Patients Having Acquired Immunodeficiency Syndrome with Cryptococcal Meningitis and Uncontrollable Intracranial Hypertension

Abstract: Patients with acquired immunodeficiency syndrome who develop cryptococcal meningitis and who suffer serious visual loss or ocular palsies with elevated pressures should be considered for cerebrospinal fluid shunting at an early stage.

Cited by 58 publications

References 7 publications

Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly

Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly

Susceptibility of Cryptococcus neoformans Biofilms to Antifungal Agents In Vitro

Cryptococcus neoformans Cells in Biofilms Are Less Susceptible than Planktonic Cells to Antimicrobial Molecules Produced by the Innate Immune System

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