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Cryptococcal Infection of the Ventriculoperitoneal Shunt in an HIV-Infected Patient with an Excellent Immunovirologic Status. 2017

Miguel Genebat, and María J Mayorga-Buiza, and Esperanza Castillo-Ojeda, and Mónica Rivero-Garvía, and Francisco J Márquez-Rivas, and Manuel E Jiménez-Mejías
Emergency Department, Virgen del Rocío University Hospital, Seville, Spain; Immunovirology Laboratory, Instituto de Biomedicina de Sevilla, Virgen del Rocío University Hospital/Centro Superior de Investigaciones Científicas/University of Seville, Seville, Spain.

BACKGROUND Cryptococcus spp. is a rare cause of ventriculoperitoneal shunt (VPS) infection, with a variable clinical presentation. Diagnosis and treatment of this entity are challenging. METHODS A cryptococcal VPS infection occurred in a human immunodeficiency virus-infected patient with an excellent immunovirologic status, with an abdominal mass as the only clinical sign at presentation. Microbiologic diagnosis was confirmed when Cryptococcus neoformans was isolated in 4 cerebrospinal fluid samples on different days. The patient was treated with dual antifungal therapy (liposomal amphotericin B plus flucytosine). The VPS was initially externalized and then removed. At 12-month follow-up, the patient remained asymptomatic, and no replacement VPS was required. CONCLUSIONS This is the first reported case of cryptococcal VPS infection in a patient with human immunodeficiency virus infection. Clinical outcome was excellent after dual antifungal therapy plus device withdrawal. Diagnosis and treatment of this entity remain a challenge for clinicians.

UI MeSH Term Description Entries
D008297 Male Males
D005437 Flucytosine A fluorinated cytosine analog that is used as an antifungal agent. 5-Fluorocytosine,Alcobon,Ancobon,Ancotil
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000666 Amphotericin B Macrolide antifungal antibiotic produced by Streptomyces nodosus obtained from soil of the Orinoco river region of Venezuela. Amphocil,Amphotericin,Amphotericin B Cholesterol Dispersion,Amphotericin B Colloidal Dispersion,Fungizone
D000935 Antifungal Agents Substances that destroy fungi by suppressing their ability to grow or reproduce. They differ from FUNGICIDES, INDUSTRIAL because they defend against fungi present in human or animal tissues. Anti-Fungal Agents,Antifungal Agent,Fungicides, Therapeutic,Antibiotics, Antifungal,Therapeutic Fungicides,Agent, Antifungal,Anti Fungal Agents,Antifungal Antibiotics
D015658 HIV Infections Includes the spectrum of human immunodeficiency virus infections that range from asymptomatic seropositivity, thru AIDS-related complex (ARC), to acquired immunodeficiency syndrome (AIDS). HTLV-III Infections,HTLV-III-LAV Infections,T-Lymphotropic Virus Type III Infections, Human,HIV Coinfection,Coinfection, HIV,Coinfections, HIV,HIV Coinfections,HIV Infection,HTLV III Infections,HTLV III LAV Infections,HTLV-III Infection,HTLV-III-LAV Infection,Infection, HIV,Infection, HTLV-III,Infection, HTLV-III-LAV,Infections, HIV,Infections, HTLV-III,Infections, HTLV-III-LAV,T Lymphotropic Virus Type III Infections, Human
D016919 Meningitis, Cryptococcal Meningeal inflammation produced by CRYPTOCOCCUS NEOFORMANS, an encapsulated yeast that tends to infect individuals with ACQUIRED IMMUNODEFICIENCY SYNDROME and other immunocompromised states. The organism enters the body through the respiratory tract, but symptomatic infections are usually limited to the lungs and nervous system. The organism may also produce parenchymal brain lesions (torulomas). Clinically, the course is subacute and may feature HEADACHE; NAUSEA; PHOTOPHOBIA; focal neurologic deficits; SEIZURES; cranial neuropathies; and HYDROCEPHALUS. (From Adams et al., Principles of Neurology, 6th ed, pp721-2) Cryptococcal Meningitis,Granulomous Cerebral Cryptococcosis,Toruloma,Cerebral Cryptococcosis,Cerebral Cryptococcoses,Cerebral Cryptococcoses, Granulomous,Cerebral Cryptococcosis, Granulomous,Cryptococcal Meningitides,Cryptococcoses, Cerebral,Cryptococcoses, Granulomous Cerebral,Cryptococcosis, Cerebral,Cryptococcosis, Granulomous Cerebral,Granulomous Cerebral Cryptococcoses,Meningitides, Cryptococcal,Torulomas
D017287 Ventriculoperitoneal Shunt Surgical creation of a communication between a cerebral ventricle and the peritoneum by means of a plastic tube to permit drainage of cerebrospinal fluid for relief of hydrocephalus. (From Dorland, 28th ed) Ventriculo-peritoneal Shunt,Shunt, Ventriculo-peritoneal,Shunt, Ventriculoperitoneal,Shunts, Ventriculo-peritoneal,Shunts, Ventriculoperitoneal,Ventriculo peritoneal Shunt,Ventriculo-peritoneal Shunts,Ventriculoperitoneal Shunts
D055499 Catheter-Related Infections Infections resulting from the use of catheters. Proper aseptic technique, site of catheter placement, material composition, and virulence of the organism are all factors that can influence possible infection. Catheter Associated Infection,Catheter Related Infection,Catheter-Associated Infections,Associated Infection, Catheter,Associated Infections, Catheter,Catheter Associated Infections,Catheter Related Infections,Catheter-Associated Infection,Catheter-Related Infection,Infection, Catheter Associated,Infection, Catheter Related,Infection, Catheter-Associated,Infection, Catheter-Related,Infections, Catheter Associated,Infections, Catheter Related,Infections, Catheter-Associated,Infections, Catheter-Related,Related Infection, Catheter,Related Infections, Catheter

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