Ventriculoperitoneal shunts in non-HIV cryptococcal meningitis

Jia Liu,Fu-Hua Peng,Feng Tan,Huan Yi,Li Xu,Min Li,Chuan Chen,Zhuo-Lin Chen

doi:10.1186/s12883-018-1053-0

Abstract

BackgroundPersistent and uncontrollable intracranial hypertension (ICH) and difficulty in reducing Cryptococcus count are severe problems in cryptococcal meningitis (CM) patients. The therapeutic effects of ventriculoperitoneal shunts (VPS) in non-HIV CM patients are not fully known, and the procedure is somewhat unusual. Here, our study offers a review to investigate the role of VPS in non-HIV CM.MethodsWe retrospectively collected data on 23 non-HIV CM patients with and without ventriculomegaly from 2010 to 2016. Their demographic data, clinical manifestations, cerebrospinal fluid (CSF) features and outcomes were analysed.ResultsWe found that non-HIV CM patients without ventriculomegaly were older, had earlier treatment times and had shorter symptom durations than CM patients with ventriculomegaly. In both groups, headache, vomiting, fever and loss of vision were the most common clinical features. CSF pressure and Cryptococcus count were significantly decreased after operation. VPS could provide sustained relief from ICH symptoms such as headache. 13% of patients had poor outcomes because of serious underlying disease, while 87% of patients had good outcomes.ConclusionsThe use of a VPS is helpful in decreasing ICH and fungal overload in non-HIV CM patients, and VPS should be performed before CM patients present with symptoms of severe neurological deficit.

Highlights

Persistent and uncontrollable intracranial hypertension (ICH) and difficulty in reducing Cryptococcus count are severe problems in cryptococcal meningitis (CM) patients
Subject clinical characteristics A cohort of 23 non-HIV CM patients who were treated with ventriculoperitoneal shunts (VPS), including 13 with ventriculomegaly (VPSV) [12 males and 1 female] and 10 without ventriculomegaly (VPSWOV) [6 males and 4 females], were enrolled in our study (Fig. 1 and Table 2)
The clinical and demographic features of the subjects were summarized in Tables 1 and 2 The male sex was predominant in both groups

Summary

Introduction

Persistent and uncontrollable intracranial hypertension (ICH) and difficulty in reducing Cryptococcus count are severe problems in cryptococcal meningitis (CM) patients. The therapeutic effects of ventriculoperitoneal shunts (VPS) in non-HIV CM patients are not fully known, and the procedure is somewhat unusual. Cryptococcus neoformans is an opportunistic pathogen and is an important cause of fungal meningitis associated with high morbidity and mortality rates. It commonly occurs in immunosuppressed patients with HIV infections or transplant conditioning, as well as in previously healthy individuals [1, 2]. There are many patients without a severe immunocompromising illness before the development of cryptococcal meningitis (CM) who have a negative HIV test result. Persistent and uncontrollable intracranial hypertension (ICH) is a severe

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Conclusion