Cryptococcal Ventricular-Peritoneal Shunt Infection: Clinical and Epidemiological Evaluation of Two Closely Associated Cases

Ingram, Christopher W.; Haywood, Hubert B.; Morris, Vicki M.; Allen, Robert Loring; Perfect, John R.

doi:10.1086/646675

Cited by 14 publications

(4 citation statements)

References 10 publications

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“…Clinical studies have reported that patients with cryptococcosis may have developed their disease after a latent infection period of a few months to a few years (20). The finding of cryptococcal infection in two patients after ventriculoperitoneal shunting suggested reactivation of a pre-existing infection (21). These cases suggest the possibility of reactivation, as has been reported for tuberculosis.…”

Section: Discussionmentioning

confidence: 63%

Three Cases of Concurrent Infection with Mycobacterium tuberculosis and Cryptococcus neoformans

et al. 2014

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Impaired cellular-mediated immunity is a known risk factor for both tuberculosis and cryptococcosis. However, pulmonary cryptococcosis associated with pulmonary tuberculosis is rare. We herein describe three cases of concurrent infection with Mycobacterium tuberculosis and Cryptococcus neoformans. All patients had underlying diseases; all three had uncontrolled diabetes mellitus, and other underlying diseases were liver cirrhosis, malignancy, and rheumatoid arthritis requiring long-term steroid use. We also review other relevant reports.

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Section: Discussionmentioning

confidence: 63%

Three Cases of Concurrent Infection with Mycobacterium tuberculosis and Cryptococcus neoformans

et al. 2014

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“…It was observed that the combination drug treatment is capable of disrupting the biofilm with killing the cells as well as disintegrate the biofilm. Biofilm formation has an important role for the C.neoformans to survive within the macrophages and to colonize in the central nervous system (CNS) [ 15 ]. Thus, disrupting the biofilm help to reducing the virulence nature to control the pathogen at the site of infection [ 16 - 17 ].…”

Section: Resultsmentioning

confidence: 99%

Combined effect of furanone fluconazole and amphotericin B against biofilms formed from Cryptococcus neoformans

Meenakumari¹

2021

Bioinformation

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It is of interest to document the combined effect of furanone fluconazole and amphotericin B against the biofilm formed by Cryptococcus neoformans. The MIC values of amphotericine B and Fluconazole were observed as 20μg/ml and 60μg/ml, respectively. The MIC for the Combination (Amphotericin B/ Fluconazole) was found to be at (15/20) μg/ml drug concentration. Thus, data shows the combined effect of furanone fluconazole and amphotericine B derivative against C. neoformans.

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“…Cryptococcal infection is a rare etiology of VPS infection. Our review of the literature showed that there have been a total of 9 reported cases [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Bacteria such as coagulase-negative staphylococci are the most commonly implicated organism [ 4 – 7 ]. 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 ].…”

Section: Introductionmentioning

confidence: 99%

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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Cryptococcal Ventricular-Peritoneal Shunt Infection: Clinical and Epidemiological Evaluation of Two Closely Associated Cases

Abstract: Our data and previous reports suggest that cryptococcal VP shunt infections appear to be a complication of shunts placed in previously infected persons rather than nosocomial transmission of cryptococcus during placement.

Cited by 14 publications

References 10 publications

Three Cases of Concurrent Infection with <i>Mycobacterium tuberculosis</i> and <i>Cryptococcus neoformans</i>

Three Cases of Concurrent Infection with <i>Mycobacterium tuberculosis</i> and <i>Cryptococcus neoformans</i>

Combined effect of furanone fluconazole and amphotericin B against biofilms formed from Cryptococcus neoformans

Cryptococcal Infection of the Ventriculoperitoneal Shunt in an Immunocompetent Patient

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