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.

Cryptococcal ventriculoperitoneal shunt infection

“…In previous cases of cryptococcal shunt infection, the time from shunt placement to symptom onset ranged from 10 days to 15 months [8,11]. The present case is exceptionally unusual, with a shunt placement to symptom onset time of more than 20 years.…”

“…The majority of patients with cryptococcal infection not associated with VP shunts are immuno-comprised [9,10]. Interestingly, five out of the nine previously reported cases of cryptococcal shunt infection had no underlying medical conditions [8]. The present patient had multiple underlying medical conditions, but was believed to be immuno-competent at the time of presentation.…”

“…Only nine cases of shunt related cryptococcal infections have been reported to our knowledge [7,8]. The majority of patients with cryptococcal infection not associated with VP shunts are immuno-comprised [9,10].…”

Fungal Infections of the Central Nervous System

“…In many of the patients with CSF shunts who were subsequently found to have C. neo formans infection, the shunts were originally placed for either idiopathic hydrocephalus or chronic culture-negative meningitis; these patients probably had chronic CNS cryptococcal infection before their shunts were inserted. 25 There are rare reports of fungal infection associated with neurosurgical procedures; among these, Aspergillus and Candida species account for most cases. [27][28][29] In some of these patients, infection was attributed to direct extension of the fungus from the paranasal sinuses, and in others it was thought that fungi were introduced with devices inserted during the operative procedure.…”

“…Among the published cases of CSF shunt infections with C. albicans, an association exists with recent antibacterial therapy and colonization with Candida species at other body sites. Other fungi that have caused CNS infection in the setting of a CSF shunt include C. neoformans, 25 Trichosporon beigelii, 26 Candida glabrata, and Candida tropicalis. There is some controversy concerning the origin of cryptococcal shunt infections.…”