Treatment of indolent, nonencapsulated cryptococcal meningitis associated with hydrocephalus

  • Sarah T. Garber | sarah.garber@hsc.utah.edu Department of Neurosurgery, College of Medicine, The University of Vermont, Burlington, Vermont, United States.
  • Paul L. Penar Department of Neurosurgery, College of Medicine, The University of Vermont, Burlington, Vermont, United States.

Abstract

Infection with cryptococcal meningitis is uncommon in immunocompetent patients. The major virulence factor is the polysaccharide capsule, while nonencapsulated mutants are generally considered nonpathogenic. The authors present a case of hydrocephalus caused by meningitis from an indolent, nonencapsulated Cryptococcus sp. requiring placement and multiple revisions of a ventriculoperitoneal shunt (VPS). The patient presented with progressively worsening occipital headaches. Computed tomography and magnetic resonance imaging showed significant hydrocephalus with no apparent cause. Her symptoms initially resolved after placement of a VPS, but returned four months later. Cultures of the shunt tubing and cerebrospinal fluid (CSF) showed no bacterial infection. When the symptoms failed to resolve, CSF fungal culture revealed Cryptococcus-like yeast, although the organisms were nonencapsulated, and the cryptococcal antigen was negative. After antibiotic therapy, the symptoms resolved. The unusual clinical presentation delayed the diagnosis, highlighting the importance of understanding the detection, diagnosis, and treatment of meningeal infections caused by C. neoformans.

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Author Biographies

Sarah T. Garber, Department of Neurosurgery, College of Medicine, The University of Vermont, Burlington, Vermont
Resident in Neurosurgery
Paul L. Penar, Department of Neurosurgery, College of Medicine, The University of Vermont, Burlington, Vermont
Assistant Professor of Neurosurgery
Published
2012-01-27
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Section
Case Reports
Keywords:
Cryptococcus neoformans, hydrocephalus, ventriculoperitoneal shunt, meningitis.
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How to Cite
Garber, S. T., & Penar, P. L. (2012). Treatment of indolent, nonencapsulated cryptococcal meningitis associated with hydrocephalus. Clinics and Practice, 2(1), e22. https://doi.org/10.4081/cp.2012.e22