{Reference Type}: Case Reports
{Title}: Ventriculoperitoneal shunt infection by Cryptococcus neoformans sensu stricto: Case report and literature review.
{Author}: Kumar A;Udayakumaran S;Sachu A;Shashindran N;Baby P;Thaha A;Kurien A;Chowdhary A;Kumar A;Udayakumaran S;Sachu A;Shashindran N;Baby P;Thaha A;Kurien A;Chowdhary A;Kumar A;Udayakumaran S;Sachu A;Shashindran N;Baby P;Thaha A;Kurien A;Chowdhary A;
{Journal}: Rev Iberoam Micol
{Volume}: 39
{Issue}: 1
{Year}: Jan-Mar 2022
{Factor}: 1.385
{DOI}: 10.1016/j.riam.2021.11.003
{Abstract}: <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>CONCLUSIONS: </B>This report underlines the need to rule out a Cryptococcus infection in those cases of chronic meningitis with hydrocephalus.