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 (0.06 mg/l), fluconazole (8 mg/l), isavuconazole (<0.015 mg/l), posaconazole (<0.03 mg/l), amphotericin B (<0.06 mg/l) and 5-fluorocytosine (1 mg/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.

中文翻译：

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狭义隐球菌脑室腹腔分流感染：病例报告及文献复习

背景

已知隐球菌脑室腹腔分流感染是由于患者的潜在感染而不是分流放置期间隐球菌的医院内传播而发生的。描述了一个被误诊为结核性脑膜炎的隐球菌性脑膜炎引起的慢性脑积水病例。

案例报告

从图表和实验室记录中提取患者详细信息。分离物的鉴定通过单磷酸乳清蛋白焦磷酸化酶 ( URA5 ) 基因的 PCR 限制性片段长度多态性得到证实。使用 CLSI M27-A3 肉汤微量稀释法测定抗真菌敏感性。此外，还进行了 Medline 搜索以查看所有脑室腹腔隐球菌分流感染病例。Cryptococcus neoformans sensu stricto（以前称为Cryptococcus neoformans var. grubii），交配型 MATα 从脑脊液和脑室外引流管尖端分离。该分离株对伏立康唑的最低抑菌浓度较低（0.06 mg/l)、氟康唑 (8  mg/l)、艾沙康唑 (<0.015  mg/l)、泊沙康唑 (<0.03  mg/l)、两性霉素 B (<0.06  mg/l) 和 5-氟胞嘧啶 (1  mg/l) . 患者接受静脉注射两性霉素 B 脱氧胆酸盐治疗，但在术后第 15 天死于心肺骤停。

结论

本报告强调了在伴有脑积水的慢性脑膜炎病例中排除隐球菌感染的必要性。