Abstract：
BACKGROUND: Cryptococcal ventriculoperitoneal shunt infection is known to occur due to an underlying infection in the patient rather than by nosocomial transmission of Cryptococcus during shunt placement. A case of chronic hydrocephalus due to cryptococcal meningitis that was misdiagnosed as tuberculous meningitis is described.
METHODS: Patient details were extracted from charts and laboratory records. The identification of the isolate was confirmed by PCR-restriction fragment length polymorphism of the orotodine monophosphate pyrophosphorylase (URA5) gene. Antifungal susceptibility was determined using the CLSI M27-A3 broth microdilution method. Besides, a Medline search was performed to review all cases of Cryptococcus ventriculoperitoneal shunt infection. Cryptococcus neoformans sensu stricto (formerly Cryptococcus neoformans var. grubii), mating-type MATα was isolated from the cerebrospinal fluid and external ventricular drain tip. The isolate showed low minimum inhibitory concentrations for voriconazole (0.06mg/l), fluconazole (8mg/l), isavuconazole (<0.015mg/l), posaconazole (<0.03mg/l), amphotericin B (<0.06mg/l) and 5-fluorocytosine (1mg/l). The patient was treated with intravenous amphotericin B deoxycholate, but died of cardiopulmonary arrest on the fifteenth postoperative day.
CONCLUSIONS: This report underlines the need to rule out a Cryptococcus infection in those cases of chronic meningitis with hydrocephalus.
METHODS: Patient details were extracted from charts and laboratory records. The identification of the isolate was confirmed by PCR-restriction fragment length polymorphism of the orotodine monophosphate pyrophosphorylase (URA5) gene. Antifungal susceptibility was determined using the CLSI M27-A3 broth microdilution method. Besides, a Medline search was performed to review all cases of Cryptococcus ventriculoperitoneal shunt infection. Cryptococcus neoformans sensu stricto (formerly Cryptococcus neoformans var. grubii), mating-type MATα was isolated from the cerebrospinal fluid and external ventricular drain tip. The isolate showed low minimum inhibitory concentrations for voriconazole (0.06mg/l), fluconazole (8mg/l), isavuconazole (<0.015mg/l), posaconazole (<0.03mg/l), amphotericin B (<0.06mg/l) and 5-fluorocytosine (1mg/l). The patient was treated with intravenous amphotericin B deoxycholate, but died of cardiopulmonary arrest on the fifteenth postoperative day.
CONCLUSIONS: This report underlines the need to rule out a Cryptococcus infection in those cases of chronic meningitis with hydrocephalus.
摘要：
背景：已知隐球菌脑室-腹腔分流术感染是由于患者的潜在感染而发生的，而不是在分流术放置过程中隐球菌的医院传播。描述了一例因隐球菌性脑膜炎而被误诊为结核性脑膜炎的慢性脑积水。
方法：从图表和实验室记录中提取患者详细信息。通过Orootodine一磷酸焦磷酸化酶（URA5）基因的PCR限制性片段长度多态性确认了分离株的鉴定。使用CLSIM27-A3肉汤微量稀释法确定抗真菌敏感性。此外,我们进行了Medline检索,以回顾所有隐球菌脑室-腹腔分流术感染病例.新生隐球菌（以前称为新生隐球菌。grubii),从脑脊液和外部心室引流尖端分离出交配型MATα。分离物对伏立康唑的最低抑制浓度低（0.06mg/l），氟康唑（8mg/l），伊沙武康唑（<0.015mg/l），泊沙康唑（<0.03mg/l），两性霉素B（<0.06mg/l）和5-氟胞嘧啶（1mg/l）。患者接受静脉注射两性霉素B脱氧胆酸盐治疗，但在术后第15天死于心肺骤停。
结论：本报告强调了在慢性脑膜炎伴脑积水病例中排除隐球菌感染的必要性。
方法：从图表和实验室记录中提取患者详细信息。通过Orootodine一磷酸焦磷酸化酶（URA5）基因的PCR限制性片段长度多态性确认了分离株的鉴定。使用CLSIM27-A3肉汤微量稀释法确定抗真菌敏感性。此外,我们进行了Medline检索,以回顾所有隐球菌脑室-腹腔分流术感染病例.新生隐球菌（以前称为新生隐球菌。grubii),从脑脊液和外部心室引流尖端分离出交配型MATα。分离物对伏立康唑的最低抑制浓度低（0.06mg/l），氟康唑（8mg/l），伊沙武康唑（<0.015mg/l），泊沙康唑（<0.03mg/l），两性霉素B（<0.06mg/l）和5-氟胞嘧啶（1mg/l）。患者接受静脉注射两性霉素B脱氧胆酸盐治疗，但在术后第15天死于心肺骤停。
结论：本报告强调了在慢性脑膜炎伴脑积水病例中排除隐球菌感染的必要性。
