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Treatment of indolent, nonencapsulated cryptococcal meningitis associated with hydrocephalus

Sarah T Garber1, Paul L Penar1

  • 1Department of Neurosurgery, College of Medicine, The University of Vermont, Burlington, Vermont, USA.

Clinics and Practice
|April 26, 2014
PubMed

Insights

A rare case of meningitis caused by nonencapsulated Cryptococcus species led to hydrocephalus in an immunocompetent patient. This unusual presentation highlights the need for comprehensive diagnosis of fungal meningitis.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Mycology

Background:

  • Cryptococcal meningitis is typically associated with encapsulated Cryptococcus species and is rare in immunocompetent individuals.
  • Nonencapsulated Cryptococcus mutants are generally considered nonpathogenic, making their role in meningitis poorly understood.
  • Hydrocephalus is a potential complication of meningitis, often requiring neurosurgical intervention.

Observation:

  • A case of hydrocephalus in an immunocompetent patient caused by an indolent, nonencapsulated Cryptococcus species is presented.
  • The patient experienced recurrent symptoms despite initial ventriculoperitoneal shunt (VPS) placement and negative bacterial cultures.
  • Diagnosis was delayed due to the nonencapsulated nature of the yeast and negative cryptococcal antigen tests.

Findings:

  • Cerebrospinal fluid (CSF) fungal cultures eventually identified Cryptococcus-like yeast, despite the absence of a capsule.
  • The patient's symptoms resolved following antibiotic therapy, suggesting an atypical response or co-infection.
  • Nonencapsulated Cryptococcus species can cause indolent meningeal infections and hydrocephalus in immunocompetent hosts.

Implications:

  • This case underscores the importance of considering nonencapsulated Cryptococcus species in the differential diagnosis of meningitis, particularly in cases of unexplained hydrocephalus.
  • Diagnostic challenges associated with nonencapsulated strains necessitate awareness and potentially broader testing strategies.
  • Further research is needed to elucidate the pathogenicity and optimal treatment of infections caused by these atypical fungal pathogens.
Keywords:
Cryptococcus neoformanshydrocephalusmeningitis.ventriculoperitoneal shunt

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