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Table 1 Summary of case reports of cryptococcal meningitis complicating ventriculoperitoneal (VP) shunt infection with or without concurrent infected intraabdominal VP shunt pseudocyst

From: Undiagnosed Cryptococcus gattii meningitis leading to subsequent ventriculoperitoneal shunt infection in a patient with symptoms of normal pressure hydrocephalus: case report and literature review

Case Author (year) Age (yrs)/ Sex Underlying conditions Onseta (mo-yrs) Clinical manifestations Findings Cryptococcus species Managements Outcomes
1–3 Mangham et al. [9] (1983) 22/M 1 yr Rapidly declined consciousness with frontal headache CT brain: hydrocephalus
Brain necropsy: basilar meningitis with yeast like organisms seen
C. neoformans ABD, 5-FC, shunt removal Dead
58/M 9 mo Progressive headache and memory deficit CT brain: hydrocephalus
Intact shunt function
C. neoformans ABD, 5-FC, shunt removal Recovery
55/M CLD, DM, NPH 4 mo Memory deficit and gait difficulty CT brain: hydrocephalus
Brain necropsy: fibrous and thickening leptomeninges with yeast like organisms seen
C. neoformans ABD, 5-FC Dead
4 Crum-Cianflone et al. [10] (2008) 34/M HIV, TB meningitis 1 yr Abdominal distention CT abdomen: intraabdominal CSF
VP shunt pseudocyst, sized 26 cm
Cyst fluid CRAG titers of 1:64
C. neoformans LAB, 5-FC then oral FLU and 5-FC, cyst aspiration and shunt removal Recovery
5 Viereck et al. [11] (2014) 65/M NPH 20 yrs Difficult ambulation and confusion Intact shunt function
Radiographic findings: no data
C. neoformans ABD, 5-FC, shunt removal and reimplant Recovery
6 Lee et al. [12] (2016) 80/M NPH 10 yrs Abdominal pain and diarrhea CT abdomen: large intraperitoneal CSF VP shunt pseudocyst C. neoformans ABD, 5-FC and shunt removal Recovery, no residual pseudocyst
7 Foong et al. [13] (2016) 52/M NPH 1 yr Fever, lethargy, confusion CT brain: hydrocephalus with possible shunt malfunction C. neoformans LAB, 5-FC then oral FLU, shunt removal and reimplant Recovery
8 Genebat et al. [14] (2017) 36/F HIV, TB meningitis 1 yr Abdominal mass CT abdomen: subcutaneous CSF VP shunt pseudocyst, sized 7 cm C. neoformans LAB, 5-FC then oral FLU, and shunt removal Recovery, no residual pseudocyst
9 The present case 66/F HT 2 yrs Gait difficulty, dizziness, headache, abdominal mass CT brain: hydrocephalsCT abdomen: intraabdominal CSF
VP shunt pseudocyst, sized 15 cm
Cyst fluid CRAG titers of > 1:1024
C. gattii ABD, FLU then oral FLU, shunt removal and reimplant Recovery, no residual pseudocyst
  1. aTemporal onset of infection following VP shunt implant
  2. Abbreviations: ABD amphotericin B deoxycholate, CLD chronic liver disease, cm centimeter. CRAG cryptococcal antigen, CSF, cerebrospinal fluid, CT computed tomography, DM diabetes mellitus, 5-FC 5-flucytosine, F female, FLU fluconazole, HIV human immunodeficiency virus, HT hypertension, LAB liposomal amphotericin B, M male, mo month, NPH normal pressure hydrocephalus, TB tuberculosis, yrs. years