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Treatment of hydrocephalus secondary to cryptococcal meningitis by use of shunting
M K Park1, D R Hospenthal, J E Bennett
1Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
Insights
Shunting is a safe and effective treatment for hydrocephalus in cryptococcal meningitis patients. Procedures can be performed during acute infection without worsening the fungal infection or delaying recovery.
Area of Science:
- Neuroscience
- Infectious Diseases
Background:
- Hydrocephalus complicating cryptococcal meningitis increases patient morbidity and mortality.
- Shunting procedures (ventriculoperitoneal and ventriculoatrial) are used, but their indications, complications, success, and timing remain unclear.
Observation:
- A review of 10 non-human immunodeficiency virus-infected patients with hydrocephalus secondary to cryptococcal meningitis who underwent shunting procedures was conducted.
- Nine of 10 patients showed improvement in dementia and gait after shunting.
- Two patients required late shunt revision.
Findings:
- Shunt placement during acute cryptococcal meningitis did not lead to dissemination of infection into the bloodstream or peritoneum.
- Shunting did not create a reservoir for difficult-to-eradicate Cryptococcus organisms.
- Shunting procedures are safe and effective for managing hydrocephalus in this patient population.
Implications:
- Shunting for hydrocephalus in cryptococcal meningitis can be initiated before mycological cure.
- Early shunting may improve neurological outcomes, including dementia and gait disturbances.
- These findings support the timely use of shunting in managing cryptococcal meningitis-associated hydrocephalus.
Abstract:
Hydrocephalus can be associated with increased morbidity and mortality in cryptococcal meningitis if left untreated. Both ventriculoperitoneal and ventriculoatrial shunting have been used in persons with cryptococcosis complicated by hydrocephalus, but the indications for and complications, success, and timing of these interventions are not well known. To this end, we reviewed the clinical courses of 10 non-human immunodeficiency virus-infected patients with hydrocephalus secondary to cryptococcal meningitis who underwent shunting procedures. Nine of 10 patients who underwent shunting had noticeable improvement in dementia and gait. Two patients required late revision of their shunts. Shunt placement in eight patients with acute infection did not disseminate cryptococcal infection into the peritoneum or bloodstream, nor did shunting provide a nidus from which Cryptococcus organisms proved difficult to eradicate. Shunting procedures are a safe and effective therapy for hydrocephalus in patients with cryptococcal meningitis and need not be delayed until patients are mycologically cured.