Cryptococcal Infection of the Ventriculoperitoneal Shunt in an Immunocompetent Patient
Cryptococcal Infection of the Ventriculoperitoneal Shunt in an Immunocompetent Patient
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DOI：
10.12659/ajcr.896171
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发表时间：
2016-01-18
影响因子：
1.2
通讯作者：
Vasquez, Gustavo
中科院分区：
文献类型：
--
作者：
Foong, Kap Sum;Lee, Ashley;Vasquez, Gustavo
目的：罕见疾病背景：脑室腹腔分流术是治疗脑积水的有效方法。脑室腹腔分流术（VPS）感染是一种常见的并发症。新型隐球菌作为一种受牵连的生物体是罕见的。在本报告中，我们描述了一名隐球菌 VPS 感染患者。病例报告：一名 52 岁男性，患有正常压力脑积水，就诊前一年植入 VPS 后的状态；他因发烧、嗜睡和精神错乱入院三天。他接受了静脉注射头孢吡肟和万古霉素治疗 VPS 感染的经验治疗。腰椎穿刺和 VPS 的脑脊液分析对于低白细胞计数、低葡萄糖和高蛋白质具有重要意义。其他检查，包括印度墨汁和隐球菌抗原，均未揭示真相。尽管接受了 5 天抗生素治疗，他仍然发烧。再次将分流管中的脑脊液送去分析，结果显示与之前的研究相似的结果，但培养物现在对新型隐球菌呈阳性。患者开始口服氟胞嘧啶和静脉注射两性霉素 B 脂质体。移除 VPS 并放置外置心室导管。该患者的症状很快得到缓解。结论：迄今为止，根据文献查阅，总共报告了 9 例隐球菌 VPS 感染病例。我们介绍的病例和文献综述强调了准确诊断隐球菌分流感染的困难。有隐球菌抗原检测假阴性且培养证实为隐球菌脑膜炎的病例报告。来自分流器的脑脊液培养仍然是识别隐球菌分流器感染的支柱。隐球菌分流感染很少见，早期诊断和治疗对于患者管理至关重要，其中包括更换分流管并同时静脉注射抗真菌药物。高度临床怀疑至关重要，建议最好从瓣膜进行分流培养。
Objective: Rare diseaseBackground: Ventriculoperitoneal shunting is an effective treatment for hydrocephalus. Ventriculoperitoneal shunt (VPS) infection is a common complication. Cryptococcus neoformans as an implicated organism is rare. In this report, we describe a patient with cryptococcal VPS infection.Case Report: A 52-year-old male with normal pressure hydrocephalus, status post implantation of VPS one year prior to the presentation; who was admitted with a fever, lethargy and confusion for three days. He was treated empirically with intravenous cefepime and vancomycin for VPS infection. The CSF analysis from both the lumbar puncture and the VPS was significant for a low white blood count, low glucose and high protein. Other workup including India ink and cryptococcal antigen was unrevealing. He remained febrile despite antibiotic treatment for 5 days. The CSF from the shunt was sent for analysis again and it demonstrated similar results from the prior study, but the culture was now positive for Cryptococcus neoformans. The patient was started on oral flucytosine and intravenous liposomal amphotericin B. The VPS was removed and an externalized ventricular catheter was placed. The patient showed rapid resolution of the symptoms.Conclusions: To date, there was a total of nine reported cases of cryptococcal VPS infection upon review of the literature. Our presenting case and the literature review highlight the difficulties in making an accurate diagnosis of cryptococcal shunt infection. There were case reports of false negative cryptococcal antigen tests with culture proven cryptococcal meningitis. The CSF culture from the shunt remains a mainstay for identifying cryptococcal shunt infection. Cryptococcal shunt infections are rare and early diagnosis and treatment is essential for patient management which involves shunt replacement with concomitant administration of intravenous antifungal medication. High clinical suspicion is crucial and shunt culture preferably from the valve is recommended.