Cryptococcal Meningitis: Its Apparent Increased Incidence in the Far East

Tay, C. H.; Chew, W; Lim, Ling Choo

doi:10.1093/brain/95.4.825

Cited by 15 publications

(7 citation statements)

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“…Of the entire series of 30 patients, 13 died, so that the overall mortality rate was 430 %. This is comparable with that in other series (Sarosi et al, 1969;Edwards et al, 1970;Tay et al, 1972;. Of the 17 survivors, nine were well and eight had a moderate to severe neurological deficit (decreased visual acuity in four, dementia in two, ataxia in one, and hemiparesis in one).…”

Section: Resultssupporting

confidence: 89%

“…The ratio of patients with cerebral cryptococcosis to those with other neurological or neurosurgical problems is high compared with that in Europe or North America. In Malaysia and in Singapore (Tay et al, 1972) there has been a steady rise in the annual number of cases identified. The most likely cause for this phenomenon is a greater awareness on the part of medical practitioners.…”

Section: Discussionmentioning

confidence: 99%

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Cerebral cryptococcosis in Malaysia.

Richardson¹,

Mohandas²,

Arumugasamy³

1976

Journal of Neurology, Neurosurgery & Psychiatry

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Section: Resultssupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Cerebral cryptococcosis in Malaysia.

Richardson¹,

Mohandas²,

Arumugasamy³

1976

Journal of Neurology, Neurosurgery & Psychiatry

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“…Despite elevated opening pressures, many of these patients do not demonstrate ventriculomegaly by imaging. 13,26,33,34,36 In this series, 28 of 38 patients with elevated opening pressures had no changes in ventricular morphology. treating elevated pressures Various treatment strategies to address elevated intracranial pressure in the management of cryptococcal meningitis have been proposed.…”

Section: Discussionmentioning

confidence: 57%

“…13,22 In HIV-negative patients, ventriculoperitoneal shunting is well described by multiple authors and has had excellent results. 6,10,11,15,19,25,27,28,33,[35][36][37] In HIV-positive patients, however, the use of shunting to treat intracranial hypertension has been surprisingly sparse. Rather, there has been a greater emphasis on the use of serial lumbar punctures and lumbar drains for therapeutic relief of CSF pressure.…”

Section: Discussionmentioning

confidence: 99%

Shunting in cryptococcal meningitis

Cherian¹,

Atmar

Gopinath³

2016

JNS

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obJective Patients with cryptococcal meningitis often develop symptomatic intracranial hypertension. The need for permanent CSF diversion in these cases remains unclear. Methods Cases of cryptococcal meningitis over a 5-year period were reviewed from a single, large teaching hospital. Sources of identification included ICD-9 codes, operative logs, and microscopy laboratory records. results Fifty cases of cryptococcal meningitis were identified. Ninety-eight percent (49/50) of patients were HIV positive. Opening pressure on initial lumbar puncture diagnosing cryptococcal meningitis was elevated (> 25 cm H 2 O) in 33 cases and normal (≤ 25 cm H 2 O) in 17 cases. Thirty-eight patients ultimately developed elevated opening pressure over a follow-up period ranging from weeks to years. Serial lumbar punctures for relief of intracranial hypertension were performed in 29 cases. Thirteen of these patients ultimately had shunting procedures performed after failing to improve clinically. Two factors were significantly associated with the need for shunting: patients undergoing shunt placement were more likely to be women (5/13 vs 0/16; p = 0.01) and to have a pattern of increasing CSF cryptococcal antigen (10/13 vs 3/16 cases; p = 0.003). All patients re-presenting with mycological relapse either underwent or were offered shunt placement. coNclusioNs Neurosurgeons are often asked to consider CSF diversion in cases of cryptococcal meningitis complicated by intracranial hypertension. Most patients do well with serial lumbar punctures combined with antifungal therapy. When required, shunting generally provided sustained relief from intracranial hypertension symptoms. Ventriculoperitoneal shunts are the favored method of diversion. To the authors' knowledge, the present study is the largest series on diversionary shunts in primarily HIV-positive patients with this problem.

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“…gattii. In a study published in 1972, 30 Singaporean patients with cryptococcal meningitis were reported (6). Only one-third of the patients had some variety of preexisting chronic disease (four had systemic lupus erythematosus and were on long-term steroid immunosuppressive treatment, and the remaining six had a disparate set of diagnoses: two of pulmonary tuberculosis, and one each of myasthenia gravis, schizophrenia, chronic lung disease, and hypertension), and none of them had a malignancy or reticulosis.…”

mentioning

confidence: 99%