Ventriculoperitoneal shunt infection by Cryptococcus neoformans sensu stricto: Case report and literature review.

BACKGROUND: Cryptococcal ventriculoperitoneal shunt infection is known to occur due to an underlying infection in the patient rather than by nosocomial transmission of Cryptococcus during shunt placement. A case of chronic hydrocephalus due to cryptococcal meningitis that was misdiagnosed as tuberculous meningitis is described. CASE REPORT: Patient details were extracted from charts and laboratory records. The identification of the isolate was confirmed by PCR-restriction fragment length polymorphism of the orotodine monophosphate pyrophosphorylase (URA5) gene. Antifungal susceptibility was determined using the CLSI M27-A3 broth microdilution method. Besides, a Medline search was performed to review all cases of Cryptococcus ventriculoperitoneal shunt infection. Cryptococcus neoformans sensu stricto (formerly Cryptococcus neoformans var. grubii), mating-type MATα was isolated from the cerebrospinal fluid and external ventricular drain tip. The isolate showed low minimum inhibitory concentrations for voriconazole (0.06mg/l), fluconazole (8mg/l), isavuconazole (<0.015mg/l), posaconazole (<0.03mg/l), amphotericin B (<0.06mg/l) and 5-fluorocytosine (1mg/l). The patient was treated with intravenous amphotericin B deoxycholate, but died of cardiopulmonary arrest on the fifteenth postoperative day. CONCLUSIONS: This report underlines the need to rule out a Cryptococcus infection in those cases of chronic meningitis with hydrocephalus.

Ventriculoperitoneal shunt infection by Cryptococcus neoformans sensu stricto: Case report and literature review

BackgroundCryptococcal ventriculoperitoneal shunt infection is known to occur due to an underlying infection in the patient rather than by nosocomial transmission of Cryptococcus during shunt placement. A case of chronic hydrocephalus due to cryptococcal meningitis that was misdiagnosed as tuberculous meningitis is described.Case reportPatient details were extracted from charts and laboratory records. The identification of the isolate was confirmed by PCR-restriction fragment length polymorphism of the orotodine monophosphate pyrophosphorylase (URA5) gene. Antifungal susceptibility was determined using the CLSI M27-A3 broth microdilution method. Besides, a Medline search was performed to review all cases of Cryptococcus ventriculoperitoneal shunt infection. Cryptococcus neoformans sensu stricto (formerly Cryptococcus neoformans var. grubii), mating-type MATα was isolated from the cerebrospinal fluid and external ventricular drain tip. The isolate showed low minimum inhibitory concentrations for voriconazole (0.06mg/l), fluconazole (8mg/l), isavuconazole (<0.015mg/l), posaconazole (<0.03mg/l), amphotericin B (<0.06mg/l) and 5-fluorocytosine (1mg/l). The patient was treated with intravenous amphotericin B deoxycholate, but died of cardiopulmonary arrest on the fifteenth postoperative day.ConclusionsThis report underlines the need to rule out a Cryptococcus infection in those cases of chronic meningitis with hydrocephalus. (AU)

AntecedentesLa infección criptocócica por contaminación de las derivaciones ventriculoperitoneales es una complicación que puede tener lugar en el paciente previamente infectado más que deberse a una transmisión nosocomial de Cryptococcus durante la colocación del dispositivo. Se describe un caso de hidrocefalia crónica por meningitis criptocócica que se diagnosticó erróneamente como meningitis tuberculosa.Caso clínicoLos datos del paciente se extrajeron de la historia clínica y de los registros de laboratorio. La identificación del aislamiento se confirmó mediante PCR de polimorfismo de longitud de fragmento de restricción del gen de la orotodina monofosfato pirofosforilasa (URA5). La sensibilidad a los antifúngicos se realizó mediante el método de microdilución en caldo CLSI M27-A3. Se realizó, además, una búsqueda en Medline para revisar todos los casos de infección por Cryptococcus asociados a derivación ventriculoperitoneal. Se aisló Cryptococcus neoformans sensu stricto (antes Cryptococcus neoformans var. grubii), tipo MATα, del líquido cefalorraquídeo y de la punta del drenaje extraventricular. El aislamiento mostró, in vitro, valores bajos de concentración mínima inhibitoria para el voriconazol (0,06mg/l), el fluconazol (8mg/l), el isavuconazol (<0,015mg/l), el posaconazol (<0,03mg/l), la anfotericina B (<0,06mg/l) y la 5-fluorocitocina (1mg/l). El paciente fue tratado con anfotericina B desoxicolato intravenoso, pero falleció por parada cardiopulmonar el decimoquinto día del postoperatorio.ConclusionesNuestro caso subraya la necesidad de descartar la presencia de Cryptococcus en los casos de meningitis crónica con hidrocefalia. (AU)